Laparoscopic Treatment of Adrenal Tumors: A Single-Center Experience with 58 Patients

Abstract

Background. The aim of this study is to discuss the laparoscopic approach and assess the immunohistochemical expression profiles of synaptophysin, Ki-67, and inhibin and patient outcomes in adrenal masses through a series of cases treated at our institution. Method. The study was conducted on 58 patients who were diagnosed with adrenal masses. All cases were operated on laparoscopically for adrenal masses. Results. Both inhibin and synaptophysin were found positive in 45 patients (77,6%). Ki-67 was negative in 11 patients, whereas it was found positive in 42 with a rate of 1%. The size of the masses ranged from 1 up to 9 cm (mean 4,3 ± 1,5). Urine hormone excretion was measured within normal ranges in 47 out of 58 patients (81%). Most of the diagnosed patients were harboring Cortical Adenoma (n: 38; 65,5%). All of the masses were successfully resected without complication except 3 patients. Because of complications of bleeding, the operation was converted to open surgery for 2 patients. Conclusion. Morbidity, mortality, and healing were comparable, regardless of tumor size, yet involvement in both laparoscopic and adrenal surgery was required. Our results suggested that laparoscopic adrenalectomy should replace open surgery as the standard treatment for most adrenal masses.

Laparoscopic Versus Open Adrenalectomy: a Retrospective Comparative Study

“…Adrenal tumors which need surgical intervention are broadly classified into functional or nonfuctional. In our study, supported by other studies ( 1 , 5 , 7 - 9 ) , the majority of operated tumors were non-functional. Younger patients were found to be more likely to have functional tumors, but in contrary to what reported by Wooten and King ( 10 ), we found that males were more likely than females to have functional adrenal tumors.…”

Modeling the Cost of Management Options for small benign non-functional adrenal incidentaloma: A Decision Tree Analysis

“…The current model includes treatment-related morbidity, because the various cost derived from the actual charge from patients and/or medical insurance bureau. Three of 21 patients had surgery complication, which is similar with other reports [9][10][11][12] . One patient complicated major hemorrhage and transferred to open surgery, another one had urinary infection and fever, the third one had pneumonia after surgery.…”

“…Loh HH 7 reported that no surgery is done due to primary adrenal malignancy during follow-up. Likewise, the morbidity of surgery is mild [9][10][11][12] . Cost may, therefore, play an important role in directing clinical decisions in this disease.…”

Ganglioneuroma, una entidad a considerar en las masas adrenales incidentales. Revisión de la literatura y reporte del primer caso de extracción completamente laparoscópica en México

“…(2) Las guías de manejo de incidentalomas adrenales de la Sociedad Europea de Endocrinología (2016) sugieren el manejo laparoscópico para lesiones de 6 cm o menores, inclusive con hallazgos radiológicos sugestivos de malignidad, pero sin evidencia de invasión local, (18) sin embargo, se han reportado casos de resección de tumores adrenales de hasta 17 cm con seguridad por mínima invasión. (10,19) Ari et al, en 2016 documentaron una serie de 58 casos de tumores adrenales tratados mediante adrenalectomía laparoscópica, en la cual reporta una media de diámetro de la tumoración de 5 cm (1-9 cm), con un rango de tiempo quirúrgico de 80 min. (55-190 min.…”

“…), sangrado promedio de 150 ml., presentando complicaciones mayores en el 3.4% de los casos (n=2), que consistieron en lesión de la vena adrenal, requiriendo conversión del procedimiento, siendo el adenoma adrenal y feocromocitoma los tumores más frecuentes; asociando esta técnica a menor pérdida sanguínea y disminución del tiempo de hospitalización, con una recuperación postquirúrgica más rápida, menor dolor y requerimiento analgésico, así como reintegración temprana a las actividades cotidianas. (19) Xie et al, en su serie de casos publicada en 2018 compararon resultados de 22 cirugías laparoscópicas vs 20 cirugías abiertas, con una perdida estimada de sangre de 69.5 vs 157.5 ml., tiempo medio de cirugía de 140.8 min. vs 129.5 min.…”