Minimally Invasive Surgery for Pediatric Adrenal Masses—Report on Four Cases

Abstract

The dignity of adrenal masses in children varies from benign lesions like adenoma and ganglioneuroma to malignant tumors like adrenocortical carcinoma and neuroblastoma. Any surgical approach, especially minimally invasive surgery (MIS), requires careful risk stratification based on oncological and technical criteria. Herein, we present four patients who underwent MIS for adrenal masses. Laboratory testing differentiated between simple cysts and adenoma, but could not identify a child with adrenocortical tumor preoperatively. Analysis of image-defined risk factors excluded vascular encasement in all cases. All patients underwent laparoscopic adrenalectomy without complications. Histopathology revealed simple cyst, ganglioneuroblastoma, adenoma, and potentially malignant adrenocortical tumor in one patient/case each. All specimen showed clear margins and no recurrence was noted at a mean follow-up of 18 months.

Robotic renal and adrenal oncologic surgery: A contemporary review

“…In the pediatric population, minimally invasive surgery (MIS) has been validated for benign tumors, but caution needs to be exercised in adrenal malignancy. In patients with image-defined risk factors, MIS may be contraindicated [ 96 ]. The lack of evidence supporting performing MIS for adrenal malignancy, and the rarity of this condition could be the reason for only one case report describing the use of the robot for adrenalectomy in malignancy.…”