EUROCRINE®: Nebennierenoperationen 2015 bis 2019 – überraschende erste Ergebnisse

Staubitz, Julia I.; Clérici, T.; Riss, P; Watzka, Felix; Bergenfelz, Anders; Bareck, Evelyne; Fendrich, Volker; Goldmann, Anton; Grafen, Franziska Carmen; Heintz, A.; Kaderli, Reto; Karakas, Elias; Kern, Beatrice; Matter, Maurice; Mogl, Martina T.; Nebiker, Christian A.; Niederle, Bruno; Obermeier, Juliane; Ringger, A.; Schmid, R.; Triponez, Frédéric; Trupka, A.; Wicke, Corinna; Musholt, T. J.

doi:10.1007/s00104-020-01277-6

Cited by 5 publications

(5 citation statements)

References 20 publications

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“…First finding was a gender specific difference: male patients were older and had more frequently myelolipomas and suspicious masses, whereas female patients were younger and had more often cortisol secreting tumors, confirming the previous observations of Alesina et al 18 . Secondly endocrine activity was present in 55% of tumors, again in accordance with other surgical and non-surgical series 3 19 .…”

Section: Discussionsupporting

confidence: 87%

“…In 40% of cases, the indication for surgery consisted in a suspicion of malignancy, confirmed in 33 (82.5%) patients in final histopathology. A 33% malignancy rate is higher than that recently reported for the Eurocrine data 19 . At the same time, our 7% rate of nonfunctional benign tumors wrongly deemed suspicious and thus removed appears lower than in the Eurocrine data, considering that their reported rate of endocrine activity is 55% and that of malignancy 15%.…”

Section: Discussioncontrasting

confidence: 65%

“…At the same time, our 7% rate of nonfunctional benign tumors wrongly deemed suspicious and thus removed appears lower than in the Eurocrine data, considering that their reported rate of endocrine activity is 55% and that of malignancy 15%. One possible reason for that is that the Eurocrine data include cases from 21 different hospitals in Germany, Austria, and Switzerland with different volumes (658 surgeries, performed in 21 hospitals over 5 years) 19 : it is possible, that not all centers included have multidisciplinary preoperative boards. Because of this 7% rate of “unnecessary” adrenal surgery despite complete adherence to the international Guidelines 5 20 , we decided to focus on these cases.…”

Section: Discussionmentioning

confidence: 99%

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Adrenal Surgery in the Era of Multidisciplinary Endocrine Tumor Boards

Hartmann

2022

Horm Metab Res

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Work up of adrenal masses includes assessment of endocrine activity and malignancy risk. There is no indication for surgical removal of nonfunctional adrenal adenomas, according to the guidelines. In the present study, we aimed at evaluating the impact of a university endocrine tumor board on the quality of the indications for adrenal surgery at our institution. One hundred consecutive patients receiving primary adrenal surgery at the University Hospital of Cologne, Germany were included. Their demographics, clinic-pathologic characteristics, treatment and outcome were analyzed. In 55 (55%) cases, indication for surgery consisted in functional benign tumors, including Conn, Cushing adenomas and pheochromocytomas. Forty (40%) tumors were referred to surgery for malignancy suspicion and 5 (5%) myelolipomas were removed due to their size. Eighty-nine percent of surgeries were performed as minimally invasive procedures. Overall morbidity included two (2%) self-limiting pancreatic fistulas after left laparoscopic adrenalectomy for pheochromocytoma. All functional tumors were confirmed benign by final histology. Only 33 (82.5%) of 40 suspicious cases turned out to be malignant. Consequently, nonfunctional benign adenomas were “unnecessarily” removed in only 7 (7%) patients, with 6 (85.7%) of them having a history of extra-adrenal cancer and all of them fulfilling criteria for surgery, according to the international guidelines. In conclusion, the endocrine tumor board provided an excellent adherence to the guidelines with most surgeries being performed either for functional or malignant tumors. In nonfunctional tumors with history of extra adrenal cancer, CT guided biopsy might be considered for obviating surgery.

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Section: Discussionsupporting

confidence: 87%

Section: Discussioncontrasting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

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Adrenal Surgery in the Era of Multidisciplinary Endocrine Tumor Boards

Hartmann

2022

Horm Metab Res

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“…Phäochromozytome(PC) stellenim deutschsprachigen Bereich die dritthäufigste Operationsindikation der Nebennieren dar [29]. Unterschied man früher benigne von malignen PC, so ist heute bekannt, dass auch vermeintlich "benigne" PCs eine -wenn auch äußerst geringe -Metastasierungswahrscheinlichkeit haben [15].…”

Section: Phäochromozytome Und Paragangliomeunclassified

Endokrine und neuroendokrine Tumoren

Riss

Scheuba

Strobel

2021

Chirurg

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ZusammenfassungEndokrine Tumoren und hier im Speziellen neuroendokrine Neoplasien des Gastrointestinaltraktes (GEP-NETs), Phäochromozytome (PCs), Paragangliome (PGL) und Schilddrüsentumoren sind Paradebeispiele für die Bedeutung von Molekularpathologie und Molekularbiologie für Diagnostik, Klassifikation und letztendlich auch die (chirurgische) Therapie dieser Erkrankungen. Bei GEP-NETs erfolgt das Grading anhand des Ki-67-Index. Dieser bestimmt die Art der molekularen Bildgebung (DOTA [1,4,7,10-Tetraazacyclododecan‑1,4,7,10-tetraessigsäure]/DOPA [3,4-Dihydroxyphenylalanin]/FDG[Fluordesoxyglukose]-PET[Positronenemissionstomographie]/CT [Computertomographie]), die mögliche Therapie (chirurgisch und/oder Radiopeptidtherapie), antiproliferative und symptomkontrollierende Therapie mit Somatostatinanaloga und letztendlich auch die Prognose. PC/PGL können hereditär auftreten (MEN2A [multiple endokrine Neoplasie Typ 2A], VHL [Von-Hippel-Lindau-Tumorsuppressor], NF1 [Neurofibromatose Typ 1], SDH[Succinat-Dehydrogenase]-Mutationen), was die chirurgische Therapie und die präoperative Medikation maßgeblich beeinflusst. Die molekulare Bildgebung hat einen hohen Stellenwert und kann bei grenzwertiger Biochemie wegweisend sein. Auch Nebennierenrindenkarzinome können genetisch determiniert sein. Bei Schilddrüsentumoren ist v. a. die Pathologie der C‑Zelle (C-Zell-Hyperplasie, medulläres Schilddrüsenkarzinom) hervorzuheben. Bei hereditärer Erkrankung (FMTC [familiäres medulläres Schilddrüsenkarzinom], MEN[multiple endokrine Neoplasie]2) ist häufig eine frühe prophylaktische Operation notwendig und verhindert das Auftreten von fortgeschrittenen Karzinomen. Aber auch die Bestimmung des Resektionsausmaßes bei follikulären Läsionen bzw. die Unterscheidung zwischen „non-invasive follicular thyroid neoplasm with papillary-like nuclear features“ (NIFTPs) und follikulären Varianten des papillären Schilddrüsenkarzinoms kann mithilfe spezifischer Marker erfolgen. Insgesamt hat die Molekularpathologie eine zunehmende Bedeutung bei diesen Entitäten und ist auch Inhalt laufender Forschungsprojekte.

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“…Although the reason for this treatment immunity remains unknown, it highlights the importance of a safe and well weighed surgical treatment strategy. Several studies suggested a survival benefit from adrenalectomy for (oligo)metastatic disease [ 10 , 11 , 12 , 13 , 14 , 15 ]. Next to this, surgical techniques have improved in the last decades by introducing minimally invasive techniques such as lateral transperitoneal adrenalectomy (LTA) and retroperitoneoscopic posterior adrenalectomy (RPA).…”

Section: Introductionmentioning

confidence: 99%

Outcomes after Surgical Treatment of Metastatic Disease in the Adrenal Gland; Valuable for the Patient?

Metman

Viëtor

Seinen

et al. 2021

Cancers

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The adrenal glands are common dissemination sites for metastasis of various solid tumors. Surgical treatment is often recommended because targeted therapies and immunotherapy are frequently ineffective for adrenal metastasis. We report the experience with short-term and long-term surgical outcomes of patients undergoing surgery for adrenal metastasis in two hospitals. A retrospective, multicenter study was performed to analyze patient characteristics, tumor-related data, perioperative outcomes, and oncological outcomes. Postoperative complications that occurred within 30 days were scored according to the Clavien Dindo classification. Metastatic adrenalectomy was performed in 95 patients. We observed an increase from an average of 3 metastatic adrenalectomies per year between 2001–2005 to 10 between 2015–2019. The most frequent underlying malignancies were colorectal and lung cancer. In 55.8%, minimal invasive adrenalectomy was performed, including six conversions to open surgery. A total of 37.9% of patients had postoperative complications, of which ileus or gastroparesis, wound problems, pneumonia, and heart arrhythmias were the most occurring complications. Improved cancer care has led to an increased demand for metastatic adrenalectomy over the past years. Complication rates of 37.9% are significant and cannot be neglected. Therefore, multidisciplinary teams should weigh the decision to perform metastatic adrenalectomy for each patient individually, taking into account the drawbacks of the described morbidity versus the potential benefits.

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EUROCRINE®: Nebennierenoperationen 2015 bis 2019 – überraschende erste Ergebnisse

Cited by 5 publications

References 20 publications

Adrenal Surgery in the Era of Multidisciplinary Endocrine Tumor Boards

Adrenal Surgery in the Era of Multidisciplinary Endocrine Tumor Boards

Endokrine und neuroendokrine Tumoren

Outcomes after Surgical Treatment of Metastatic Disease in the Adrenal Gland; Valuable for the Patient?

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