Laparoscopic Versus Open Adrenalectomy for Adrenocortical Carcinoma: Surgical and Oncologic Outcome in 152 Patients

Brix, David; Allolio, Bruno; Fenske, Wiebke; Agha, Ayman; Dralle, Henning; Jurowich, Christian; Langer, Peter; Mussack, Thomas; Nies, C.; Riedmiller, H.; Spahn, Martin; Weismann, Dirk; Hahner, Stefanie; Fassnacht, Martin

doi:10.1016/j.eururo.2010.06.024

Cited by 260 publications

(147 citation statements)

References 27 publications

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“…Miller et al [16] suggested an open approach in patients suspected of, or with known ACC. By contrast, Brix et al [17] reported no significant difference between an open and laparoscopic approach for a localized ACC with a size <10 cm. Excellent preoperative imaging and intraoperative laparoscopic ultrasound are useful tools for evaluation of tumor extension and invasion before surgical resection.…”

Section: Discussionmentioning

confidence: 95%

Transperitoneal laparoscopic adrenalectomy: a review and single-center experience

et al. 2014

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Background: Laparoscopic adrenalectomy (LA) is the preferred approach to adrenal gland tumors. Objective: To evaluate the perioperative and functional outcomes of transperitoneal LA. Methods: We retrospectively reviewed data of all consecutive patients who underwent transperitoneal LA at our institution between April 2000 and December 2011. Results: Two hundred two patients with mean age of 46 years were included in the study. There were 109 left, 89 right, and 4 bilateral tumors. Preoperative diagnosis included 126 aldosterone-producing adenomas (APA), 33 patients with Cushing syndrome, 19 pheochromocytomas, 20 nonfunctional tumors, and 4 adrenal metastases. Mean tumor size was 3.3 cm (range 0.4-22 cm). Mean operative time was 109 min and estimated blood loss 90 mL for unilateral adrenalectomy; and 195 min and 300 mL for bilateral adrenalectomy. Four patients with pheochromocytoma required transfusion and 2 required conversion to an open approach. Seven intraoperative complications and 18 30-day postoperative complications occurred. These included 5 major complications (Clavien-Dindo grade 3-5). Ninety-seven percent of APA patients had normal serum potassium levels after surgery. Among the patients with functioning endocrine tumors, complete resolution rate from secondary hypertension was significantly higher in the pheochromocytoma group compared with those with APA or Cushing syndrome (82% vs. 48% vs. 68% respectively, p = 0.02). Mean follow up was 35.2 months. Conclusion: LA is the treatment of choice for most adrenal gland tumors with excellent outcomes and low complication rates. There was a high chance for complete resolution of secondary hypertension after surgery for pheochromocytoma.

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Section: Discussionmentioning

confidence: 95%

Transperitoneal laparoscopic adrenalectomy: a review and single-center experience

et al. 2014

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“…Os dois grupos foram semelhantes em metástases locais, peritoneais e distantes. Em uma das maiores séries (152 pacientes) com tumores <10 cm, Brix et al observaram recidiva tumoral e carcinomatose peritoneal, respectivamente, em 77% e 3% dos pacientes após adrenalectomia laparoscópicaversus 69% e 3% dos pacientes apósadrenalectomia aberta; a diferença, no entanto, não foi estatisticamente significativa 19 . Não existe consenso na literatura quanto à contraindicação à técnica laparoscópica em função do tamanho da adrenal, porém Gagner et al 9 evidenciaram que massas >15 cm são mais bem abordadas por via aberta.…”

Section: Discussionunclassified

Experiência De 20 Anos Em Adrenalectomia Videolaparoscópica

Gatelli¹,

Migliavacca²,

Guimarães³

et al. 2017

Clin. Biomed. Res.

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RESUMOIntrodução: As operações na glândula adrenal são realizadas para determinados cânceres, todas as massas biologicamente ativas, metástases, massas com mais de 4-5 cm encontradas incidentalmente e hiperplasia adrenal primária. Métodos:Estudo transversal e descritivo. Foram analisados os prontuários dos pacientes submetidos a adrenalectomia videolaparoscópica entre agosto de 1994 e novembro de 2014. Resultados:Foram realizadas 146 adrenalectomias videolaparoscópicas. Em 134 casos, foi realizada com sucesso, mas em 12 casos (8,2%), o procedimento foi convertido. Foram 97 pacientes do sexo feminino e 49 do sexo masculino, com idade variando de 9 a 81 anos (média de 46,7 anos). Foram removidas 56 adrenais direitas, 75 esquerdas e 15 bilaterais. O tamanho médio das adrenais foi de 5,7 cm, variando de 0,9 a 15 cm. A mediana do tempo de internação hospitalar pós-operatória foi de 4,5 dias. A mediana do tempo de cirurgia foi de 144 minutos. Houve complicações em 22,5% dos casos (maiores -casos em que houve conversão para cirurgia aberta, necessidade de reinternação hospitalar e óbito-e menores), sendo 10,9% complicações intraoperatórias e 11,6% pós-operatórias. Apenas sete (4,7%) pacientes foram considerados complicações maiores. Conclusão:A cirurgia realizada em nosso serviço está de acordo com o descrito na literatura, com taxas aceitáveis de complicações, com motivos de conversão compatíveis e com as indicações totalmente aceitáveis e condizentes. A adrenalectomia videolaparoscópica é a cirurgia de escolha para patologias cirúrgicas da glândula adrenal, exceto em casos de carcinoma adrenal localmente invasivo com comprometimento de outras estruturas. Palavras-chave: Glândulas suprarrenais; adrenalectomia; laparoscopia ABSTRACTIntroduction: Adrenal gland surgery is performed for some types of cancer, all biologically active masses, metastases, masses larger than 4-5 cm found incidentally, and primary adrenal hyperplasia.

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“…However, all these studies were retrospective in nature and included few patients with laparoscopic approach. Besides other studies showed opposite results, suggesting a comparable oncologic outcome for the two procedures (25,26). Even though a diagnosis of ACC was suspected preoperatively, a laparoscopic procedure was chosen in the present patient for several reasons: the tumor appeared localized and measured !10 cm in diameter, and the surgeon was highly experienced in adrenal tumor surgery.…”

Section: Discussionmentioning

confidence: 99%

Primary adrenal angiosarcoma and functioning adrenocortical adenoma: an exceptional combined tumor

Lepoutre-Lussey

Rousseau²,

Ghuzlan³

et al. 2012

European Journal of Endocrinology

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Context: Primary adrenal angiosarcoma is an extremely rare neoplasm, as are combined tumors within a given adrenal lesion. Clinical presentation and intervention: A 35-year-old man presented with hypokalemic hypertension leading to the discovery of a 6 cm diameter malignant-appearing right adrenal tumor. The lesion displayed marked 18 F-fluorodeoxyglucose uptake on positron emission tomography scanning. Endocrine investigations revealed secretion of both cortisol and aldosterone by the neoplasm. The entire right adrenal gland along with the periadrenal fat tissue was removed during laparoscopic surgery. Results: Histological examination revealed two intermingled tumor cell proliferations, namely an angiosarcoma and an adrenocortical adenoma. An extensive post-operative search revealed no other primary tumor site, nor metastases. The lesion was then considered to be a primary adrenal angiosarcoma combined with a secreting adrenocortical adenoma. The patient received four cycles of chemotherapy (adriamycin/ifosfamide). At 2-year follow-up, he is alive and well, with no sign of relapse. Conclusion: To the best of our knowledge, this is the first case of an adrenal neoplasm combining a primary angiosarcoma and a functioning adrenocortical adenoma.

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Laparoscopic Versus Open Adrenalectomy for Adrenocortical Carcinoma: Surgical and Oncologic Outcome in 152 Patients

Cited by 260 publications

References 27 publications

Transperitoneal laparoscopic adrenalectomy: a review and single-center experience

Transperitoneal laparoscopic adrenalectomy: a review and single-center experience

Experiência De 20 Anos Em Adrenalectomia Videolaparoscópica

Primary adrenal angiosarcoma and functioning adrenocortical adenoma: an exceptional combined tumor

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