Laparoscopic adrenalectomy – indications and selection criteria
Authors:
V. Procházka 1; Z. Kala 1; M. Jíra 1; K. Starý 2; Š. Bohatá 3; I. Penka 1
Authors‘ workplace:
Chirurgická klinika FN Brno Bohunice a LF MU Brno, přednosta: Prof. MUDr. Zdeněk Kala CSc.
1; Interní gastroenterologická klinika FN Brno Bohunice a LF MU Brno, přednosta: Prof. MUDr. Aleš Hep, CSc.
2; Radiologická klinika FN Brno Bohunice a LF MU Brno, přednosta: Prof. MUDr. Vlastimil Válek, CSc.
3
Published in:
Rozhl. Chir., 2012, roč. 91, č. 4, s. 230-234.
Category:
Original articles
Overview
Introduction:
Laparoscopic adrenalectomy has become a standard surgical procedure for the most of adrenal gland disorders. Hormonal active adenomas, feochromocytomas even some malignant tumors are the most frequent indications. The number of operations for accidentally diagnosed foci has grown rapidly. It has been suggested to revise recommendations specifying criteria, based on which incidentaloma is indicated for adrenalectomy. The aim of this work is to compare the results of adrenalectomies for hormonal active lesions and incidentalomas.
Material and methods:
An analysis of 65 patients who underwent adrenalectomy in the Department of Surgery University Hospital Brno Bohunice from 2005 to 2010. Correlation between preoperative examination outcomes and postoperative histology findings was performed. Furthermore, findings in patients indicated for surgery for hormonally active versus for hormonally inactive suprarenal tumors were compared.
Results:
Thirty-eight patients underwent laparoscopic surgery for hormonally active adrenal tumors, one for bilateral metastasses of bronchogenic carcinoma. In 26 cases adrenalectomy was indicated for incidentaloma. Adrenal hyperplasia was the commonest histological finding in the group with hormonally inactive tumors. No carcinoma was detected in this group.
In 5 of 19 patients operated for suspective feochromocytoma, the procedure did not result in blood pressure adjustment and feochromocytoma was histologically confirmed in 11 out of the 19 subjects. The size of the tumors was significantly higher in incidentalomas, compared to hormonally active pathologies. No incidentaloma and hypertension subjects experienced alteration in their clinical condition after the procedure.
Conclusion:
Laparoscopic adrenalectomy is a standard procedure in the majority of hormonally active focal suprarenal conditions. Patients with accidentally detected suprarenal tumors should be carefully indicated, taking into consideration internal comorbidities and any surgical procedures in a patientęs history. The benefit of adrenalectomy for the clinical condition alteration is arguable in incidentalomas. The National Institutes of Health USA (NIH) consensus guidlines should be strictly followed druing the decision making proces. Indication for adrenalectomy in tumors of less than 6 cm and with benign appearance on CT or MRI is not considered rational.
Key words:
adrenalectomy – laparoscopy – incidentaloma – hormonal – activity – carcinoma
Sources
1. Jacobs JK, Goldstein RE, Geer RJ. Laparoscopic adrenalectomy: a new standard of care. Ann Surg 1997;225:495–502.
2. Chavez-Rodriquez J, Pasieka JL. Adrenal lesions assessed in the era of laparoscopic adrenalectomy: a modern day series. Am J Surg 2005; 189:581–586.
3. Rayan SS, Hodin RA. Short-stay laparoscopic adrenalectomy. Surg Endoscop 2000;14:568–72.
4. Brunt LM. The positive impact of laparoscopic adrenalectomy on complications of adrenal surgery. Surg Endosc 2002;16:252–257.
5. Brunt LM, Moleey JF, Doherty GM. Outcomes analysis in patients undergoing laparoscopic adrenalectomy for hormonally active adrenal tumors. Surgery 2001;130:629–635.
6. Brauckoff M, Thanh PN, Gimm O, et al. Functional results after endoscopic subtotal cortical-sparing adrenalectomy. Surg today 2003;33:342–348.
7. Lucas SW, Spitz JD, Arregui ME. The use of intraoperative ultrasound in laparoscopic adrenal surgery. Surg Endosc 1999;13:1093–1098.
8. Gawande A, Moore FD Jr. Laparoscopic adrenalectomy. Curr. Opin. Endocrinol. Diabetes 2006;13:248–253.
9. Inabet WB, Pitre J, Bernard D, Chapuis Y. Comparison of hemodynamic parameters of open and laparoscopic adrenalectomy for pheochromocytoma. World J Surg 2000;24:574–548.
10. Tiberio GA, Baiocchi GL, Arru L, Agabiti Rosei C, et al. Prospective randomized comparison of laparoscopic versus open adrenalectomy for sporadic pheochromocytoma. Surg Endosc 2008;22:1435–1439.
11. Gonzalez RJ, Shapiro S, Sarlis N, et al. Laparoscopic resections of adrenal cortical carcinoma: a cautionare note. Surgery 2005;138:1078–1086.
12. Nies C, Langer P. Minimally invasive adrenalectomy and malignant adrenal tumors. Eur Surg 2003;35:76–79.
13. Sarela AI, Murphy I, Coit DG, et al. Metastasis to adrenal gland: the emerging role of laparoscopic surgery. Ann Surg Oncol 2003;10:1191–1196.
14. NIH State of the Science Statement on management of the clinically inapparent adrenal mass („incidentaloma“). NIH Consensus State Sci Statements 2002;19:1–23.
15. Kasalický M, Kršek M, Zelinka T, Hána V, Widimský J. 120 laparoskopických adrenalektomií s harmonickým skalpelem. Rozhl Chir 2009;88:439–443.
16. Stránský P, Hora M, Eret V, Klečka J, Ürge T, Grégrová H, Dvořáková E, Hes O, Chudáček Z, Kreuzberg B. Laparoskopická adrenalektomie. Rozhl Chir 2009; 88:514–520.
17. Zeh HR, Undelman R. One hundred laparoscopic adrenalectomies: a single surgeons experience. Annals Surg Oncol 2003;10:1012–1017.
18. Zeiger MA, Siegelman SS, Hamrahian AH. Medical and surgical evaluation and treatment of adrenal incidentalomas. J Clin Endocrinol Metab 2011;96:2004–2015.
19. Giordano R, Marinazzo E, Berardelli R, Picu A, Maccario M, et al. Long-term morphological, hormonal and clinical follow-up in single unit on 118 patients with adrenal incidentalomas. Eur J Endocrinol 2010;162:779–785.
20. Cawood TJ, Hunt PJ, OęShea D, Cole D, Soule S. Recommended evaluation of adrenal incidentalomas is costly, has high false-positive rates and confers a risk of fatal cancer that is similar to the risk of the adrenal lesion becoming malignant; time for a rethink? Eur J Endocrinol 2009;161:513–527.
21. Marko L, Vladovič P, Kokorák L. Laparoskopická adrenalektómia. Miniinvazívna chirurgia a endoskopia 2011;3:11–16.
22. Izaki H, Fukumori T, Takahashi M, Taue R, Kishimoto T, Tanimoto S, Nishitani M, Kanayama HO. Indications for laparoscopic adrenalectomy for non-functional adrenal tumor with hypertension: Usefulness of adrenocortical scintigraphy. International Journal of Urology 2006;13:677–681.
23. Mouracade P, Dettloff H, Schneider M, Debras B, Jung JL. Radio-frequency ablation of solitary adrenal gland metastasis from renal cell carcinoma. Urology 2009;74:1341–1343.
24. Mayo-Smith WW, Dupuy DE. Adrenal neoplasms: CT-guided Radiofrequency ablation-preliminary results. Radiology 2004; 231:225–230.
25. Brunaud L, Kabebew E, Sebag F, Zarnegar R, Clark OH, Duh QY. Observation or laparoscopic adrenalectomy for adrenal incidentaloma? A surgical decision analysis. Med Sci Monit 2006;12:355–362.
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Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
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