Open adrenalectomy in the era of laparoscopic surgery: a review

Taffurelli, Giovanni; Ricci, Claudio; Casadei, Riccardo; Selva, Saverio; Minni, Francesco

doi:10.1007/s13304-017-0440-1

Cited by 23 publications

(16 citation statements)

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“…Functional adrenal tumors and local invading lesions require more preoperative preparation [3] and may even affect the choice of surgical approach [7]. Because the possibility of an uncomplete curative resection with the laparoscopic adrenalectomy, open adrenalectomy is indicated in some cases [12]. The clinical, imaging, and pathological features of LATs play an important role in preoperative judgment of the nature of each tumor and selection of the best treatment.…”

Section: Introductionmentioning

confidence: 99%

Clinical analysis of adrenal lesions larger than 5 cm in diameter (an analysis of 251 cases)

et al. 2019

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BackgroundTo describe the pathological distribution, imaging manifestations, and surgical managements and prognosis of large adrenal tumors (LATs) ≥ 5 cmMethodsA total of 251 patients with LATs were analyzed on the basis of pathological or clinical diagnosis. Regarding surgery, open adrenalectomy was performed on 89 patients, and laparoscopic adrenalectomy was performed on 89 patients. Thirty-two patients with bilateral tumors were analyzed in terms of clinical characteristics. The survival rate was determined for 43 patients with adrenal metastases and 29 patients with primary adrenal malignancies. The CT characteristics including tumor diameter, shape, edge, heterogeneity, necrosis, calcification, pre-contrast attenuation, and contrast attenuation were analyzed for 117 patients.ResultsThe majority of LATs were still benign, but they had a higher probability to be malignant. Benign LATs made up 68.13% of all cases, mainly adrenal cysts (19.52%), pheochromocytoma (18.73%), benign adenoma (16.73%), and myelolipoma (7.17%). Malignant LATs accounted for 28.69% of cases, mainly including adrenocortical carcinoma (8.76%) and metastases (17.13%). Laparoscopic surgery was found to involve less trauma than open surgery. It was also safer and postoperative recovery was faster, but it had drawbacks and could not completely replace open surgery. CT features had obvious specificity for the diagnosis of benign and malignant tumors. For example, benign adenomas had a smaller pre-contrast (< 10 Hu) whereas malignant adrenal tumors had, on the contrary, higher attenuation. Regarding adrenal malignant carcinoma, adrenal primary malignant tumors showed a better prognosis than adrenal metastases (mean survival of 19.17 months vs 9.49 months). Primary adrenal cortical carcinoma without metastasis had a better prognosis than primary adrenal cortical carcinoma metastasis (mean survival of 23.71 months vs 12.75 months), and adrenal solitary metastasis had a better prognosis than general multiple metastatic carcinoma (mean survival of 14.95 months vs 5.17 months).ConclusionLATs were more likely to be benign; however, they still had a high probability of being a malignant tumor. Understanding the clinicopathological characteristics of LATs can facilitate selection of more effective clinical treatment options.

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Section: Introductionmentioning

confidence: 99%

Clinical analysis of adrenal lesions larger than 5 cm in diameter (an analysis of 251 cases)

et al. 2019

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“…Contraindications for LA are comprised of suspicious or proven malignant mass, local advanced cancer or large tumor size. With new dissection and vascular sealing devices, LA can be used in large adrenal masses 20,21 .…”

Section: Discussionmentioning

confidence: 99%

“…Hemostasis may be difficult laparoscopically if intraoperative bleeding is accompanied by a hypertensive crisis during surgery. In addition, pheochromocytoma shows strong adhesions to surrounding tissues with a desmoplastic reaction 20 . While current guidelines of the National Comprehensive Cancer Network (NCCN) recommend open surgery in tumors with a high risk of malignancy; laparoscopic surgery should be the preferred method since it is safe and applicable 34 .…”

Section: Discussionmentioning

confidence: 99%

Adrenal kitlelerde laparaskopik ve açık cerrahi tekniklerin sonuç açısından karşılaştırılması

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Ünal

et al. 2019

Cukurova Medical Journal

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The aim of this study was to compare the results of conventional and laparoscopic adrenalectomy in adrenal mass cases operated on during a 9-year period. Materials and Methods: A total of 81 patients who underwent adrenalectomy were included in the study. Patients were divided into two groups as; Group 1conventional surgery and Group 2-laparoscopic surgery. Two groups were compared retrospectively on characteristics such as; age, sex, body mass index (BMI), American Society of Anesthesiologists' score (ASA), mass localization, mass size and hormonal activity of the mass, duration of operation, amount of bleeding in operation, duration of hospitalization, duration until food intake, perioperative mortality, early complications and readmission to hospital within 90 days. Results: There were 22 patients in Group 1 and 59 patients in Group 2. No statistically significant difference was found between the groups in terms of age, sex, BMI, ASA score, tumor localization, indications for operation, postoperative complication, perioperative mortality and re-admittance within 90 days. The hormonal activity of the mass was higher and the mass was smaller in size in Group 2. The duration of operation (min), the amount of bleeding in the operation (ml), the duration until oral intake (days) and the length of hospital stay (days) were found to be statistically significantly higher in Group 1. Conclusion: Laparoscopic adrenalectomy should be the preferred surgical method because of its short duration of operation, low blood loss, early onset of oral food intake and shorter hospital stay, as well as its safety. Amaç: Bu çalışmada, 9 yıl içerisinde adrenal kitle nedeni ile ameliyat edilen olgularda konvansiyonel ve laparoskopik adrenalektominin sonuçlarının karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Adrenalektomi uygulanan 81 hasta çalışmaya dahil edildi. Grup 1 konvansiyonel, Grup 2 Laparaskopik cerrahi olarak hastalar iki grupa ayrıldı. İki grup, yaş, cinsiyet, vücut kitle indeksi (VKİ), Amerikan anestezistler derneği skoru (ASA), kitle lokalizasyonu, kitle büyüklüğü ve kitlenin hormonal aktivitesi, operasyon süresi, operasyonda kanama miktarı, yatış süresi, gıdaya başlama süresi, perioperatif mortalite, erken dönem komplikasyonlar ve 90 gün içinde hastaneye tekrar başvuru gibi özellikleri esas alınarak retrospektif olarak karşılaştırıldı. Bulgular: Grup 1'de 22, Grup 2'de 59 hasta mevcut idi. Gruplar arasında yaş, cinsiyet, VKİ, ASA skoru, tümör lokalizasyonu, operasyon endikasyonları, postoperatif komplikasyon, perioperatif mortalite ve 90 gün içinde tekrar başvuru açısından istatistiksel olarak anlamlı fark saptanmadı. Kitlenin hormonal aktivitesi Grup 2'de daha yüksek, boyutu ise daha küçük saptandı. Operasyon süresi (dak), ameliyatta kanama miktarı (ml), oral alım süresi (gün) ve hastanede yatış süresi (gün) Grup 1'de daha fazla ve istatiksel olarak anlamlı bulundu. Sonuç: Laparoskopik adrenalektomi uygun hastalarda, kısa operasyon süresi, az kan kaybı, oral gıdaya erken başlama süresi ve daha kısa hastanede kalış sü...

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“…If there are signs of invasion to adjacent organs (e.g., vena cava, liver, pancreas, bowels, kidney), an open transabdominal approach is generally recommended (39). Depending on the experience of the "endocrine" surgeon, other specialists may need to be involved (e.g., vascular surgeons, upper-GI-hepatobiliary-surgeons, lower-GIsurgeons, urologists).…”

Section: Tumors With Signs Of Infiltration/invasionmentioning

confidence: 99%

Challenges of training in adrenal surgery

Gimm¹,

Duh²

2019

Gland Surg

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While adrenal tumors are common, adrenalectomy is rather uncommon. This is one reason for the many challenges regarding the training of adrenal surgery. Here we focus on issues that are most pertinent regarding training of the young surgeons performing adrenalectomy. Due to the very limited literature, what is presented is mainly based on personal experience and/or from the literature published for other surgical operations and subspecialties. The discussed challenges include indications for surgery, surgical approaches and extent, and intraoperative complications. With advances in adrenal surgery, we expect some old challenges to be resolved, and some new challenges to arise. These challenges will be faced in order to continue to help our younger trainee acquire the knowledge and skills to best care for our patients with adrenal diseases.

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Open adrenalectomy in the era of laparoscopic surgery: a review

Cited by 23 publications

References 50 publications

Clinical analysis of adrenal lesions larger than 5 cm in diameter (an analysis of 251 cases)

Clinical analysis of adrenal lesions larger than 5 cm in diameter (an analysis of 251 cases)

Adrenal kitlelerde laparaskopik ve açık cerrahi tekniklerin sonuç açısından karşılaştırılması

Challenges of training in adrenal surgery

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