Perioperative Outcomes After Adrenalectomy for Malignant Neoplasm in Laparoscopic Era

Abstract

Overall, LA had better outcomes than OA. When comparisons were made between LA and OA for benign adrenal diseases, all outcomes were significantly better in the laparoscopic group. There were, however, no statistical differences when LA was compared with OA for malignant diagnoses.

Changing USA national trends for adrenalectomy: the influence of surgeon and technique

“…The largest comparative studies report on 152 300 and 478 patients, respectively, who underwent adrenalectomy, comparing open and MIS, and none found a difference in surgical outcomes [13][14][15]. Although we were surprised by the fact that only 20% of the cases in the present study were performed by MIS, this rate corresponds to findings by Shaligram et al [2] who previously reported a 17% MIS rate in their adrenalectomy cohort. Considering the rapid uptake of MIS in other urological oncology procedures (Supplemental Figure), it is surprising that we found only a 4% increase in MIS use over the 10-year period.…”

“…However, when examining only patients with Stage I or II adrenocortical carcinoma, most studies found similar rates of recurrence for the open and MIS approaches [13,24,25]. Although we are unable to evaluate pathological results in our present study, nearly every published study on patients with malignant tumours of the adrenal gland found that MIS had equivalent or lower hospitalisation time and postoperative complications when compared with open surgery [2,21,22,24]. Thus, while size and extent of the tumour should contribute to a surgeon's decision of how to operate on the adrenal gland, the proportion of patients who would benefit from MIS adrenalectomy is likely higher than those currently being offered MIS.…”

“…Isolated adrenalectomy is typically performed for large or enlarging inactive or active benign tumours, functional/metabolic disorders of the adrenal gland (Conn's or Cushing syndrome), and the rare solitary metastasis or malignant tumour (adrenocortical carcinoma).Whether adrenalectomy is performed using minimally invasive surgery (MIS) or open techniques is largely left up to surgeon preference. Laparoscopic and robot-assisted adrenalectomies are frequently considered the treatment of choice for benign adrenal tumours and metabolic disorders of the adrenal gland [1][2][3]; however, the role of MIS for malignant tumours remains unclear. In contrast to other extirpative urological surgeries for malignancy that have shown an increase in MIS use (radical prostatectomy [RP], partial nephrectomy [PN]), oncological equivalence relative to open adrenalectomy (surgical margin rates, absence of spillage, recurrence-free survival) is less well established.…”

Risk factors for 30-day readmission after adrenalectomy

“…5 Currently, adrenalectomy is performed for both benign and malignant disease and is approached commonly by both open surgery and laparoscopy or another minimally invasive approach. Outcomes after adrenalectomy have been examined by surgeon specialty 6 , operative approach 7,8 , and presence of malignancy 7 with readmission rates reported between 1.5% and 11,3%., 6,7,9 but, specific risk factors for readmission after adrenalectomy have not been reported previously.…”

Outcome of laparoscopic adrenalectomy for resection of unilateral noninvasive adrenocortical tumors in 11 cats

“…Laparoscopic adrenalectomy (LA) is the treatment of choice for noninvasive unilateral tumors in humans . Evidence of this approach in cats is limited to 1 case report, describing the successful management of a cat with LA .…”