Approach to large adrenal tumors

Abstract

Purpose of review To summarize the data concerning approach to large adrenal tumors (LAT's), since recent guidelines published in 2016 recommend individual approach rather than clear size cut-off of a tumor that should be removed. Recent findings Although the risk of malignancy clearly correlates with the size of a lesion, tumor size of more than 4 cm in diameter represents only 31–61% specificity for the diagnosis of malignant tumor. Therefore, the risk of malignancy and decision about surgery should not be based only on the size of a tumor but assessed in terms of imaging studies, growth pattern during follow-up and new tool that is urine/serum steroid metabolomics. Summary Approach to patients with LAT's should be individualized. Patients with LAT's should be managed by an expert multidisciplinary team, that includes an endocrinologist, a radiologist, a pathologist, and an adrenal surgeon.

A commentary on ‘Safety and effectiveness of minimally invasive adrenalectomy versus open adrenalectomy in patients with large adrenal tumors (≥5 cm): a meta-analysis and systematic review’

“…In the last decade, urologists have become increasingly interested in minimally invasive adrenalectomy (MIA), such as laparoscopic adrenalectomy and robot-assisted adrenalectomy. With the addition of experience and the development of state-of-the-art techniques, a mountain of evidence suggests that MIA is safe and feasible in carefully selected patients and converted to open if the local invasion is identified during the laparoscopic procedure 1 – 3 . Therefore, some centers propose MIA as an alternative treatment.…”