Open versus endoscopic adrenalectomy in the treatment of localized (stage I/II) adrenocortical carcinoma: Results of a multiinstitutional Italian survey

Lombardi, Celestino Pio; Raffaelli, Marco; Crea, Carmela De; Boniardi, Marco; Toma, Giorgio De; Marzano, Luigi; Miccoli, Paolo; Minni, Francesco; Morino, Mario; Pelizzo, Maria Rosa; Pietrabissa, Andrea; Renda, Andrea; Valeri, Andrea; Bellantone, Rocco Domenico Alfonso

doi:10.1016/j.surg.2012.08.014

Cited by 114 publications

(104 citation statements)

References 23 publications

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“…Nine cohort studies on the surgical treatment of patients with nonmetastatic adrenocortical carcinoma were included (151,152,153,154,155,156,157,158,159). Three studies reported on the patients in whom complete resection of the tumor was achieved (153,155,159).…”

Section: Surgical Approach: Open Vs Minimally Invasive Adrenalectomy mentioning

confidence: 99%

“…In this study, none of the 152 patients died perioperatively. Three studies reported on intraoperative or postoperative complications (154,155,158). Major postoperative complications (Clavien-classification score 3-5) occurred more often in open surgeries compared with laparoscopic surgeries (RR 1.7, 95% CI: 0.5-6.2), but these estimates are imprecise due to low numbers of events.…”

Section: Perioperative Mortality and Morbiditymentioning

confidence: 99%

“…These studies also provided data on overall or disease-specific survival (151,152,153,154,155,157,158,159). There is no compelling evidence that one of the approaches (laparoscopic or open adrenalectomy) is superior with regard to time to recurrence and/or survival in patients with adrenocortical carcinoma, provided that rupture of tumor capsule is excluded.…”

Section: Recurrence-free and Overall Survivalmentioning

confidence: 99%

“…Although we cannot provide a specific number of required operations per year, we have no doubts that surgical volume correlates with better outcome. As summarized above (Section 4.3), there are nine cohort studies on surgery for localized adrenocortical carcinoma comparing laparoscopic vs open adrenalectomy, each with more than ten patients per group (151,152,153,154,155,156,157,158,159), but these studies are, however, hampered by methodological flaws, and importantly, none was randomized. Nevertheless, based on these data and the clinical experience of the guideline group members, it was judged that laparoscopic adrenalectomy may be justified for tumors with radiological signs of malignancy, but only where there was no evidence of local invasion.…”

Section: Reasoningmentioning

confidence: 99%

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Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Fassnacht

Arlt

Bancos

et al. 2016

European Journal of Endocrinology

1,299

1,571

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By definition, an adrenal incidentaloma is an asymptomatic adrenal mass detected on imaging not performed for suspected adrenal disease. In most cases, adrenal incidentalomas are nonfunctioning adrenocortical adenomas, but may also represent conditions requiring therapeutic intervention (e.g. adrenocortical carcinoma, pheochromocytoma, hormone-producing adenoma or metastasis). The purpose of this guideline is to provide clinicians with best possible evidence-based recommendations for clinical management of patients with adrenal incidentalomas based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. We predefined four main clinical questions crucial for the management of adrenal incidentaloma patients, addressing these four with systematic literature searches: (A) How to assess risk of malignancy?; (B) How to define and manage low-level autonomous cortisol secretion, formerly called 'subclinical' Cushing's syndrome?; (C) Who should have surgical treatment and how should it be performed?; (D) What follow-up is indicated if the adrenal incidentaloma is not surgically removed? Selected recommendations: (i) At the time of initial detection of an adrenal mass establishing whether the mass is benign or malignant is an important aim to avoid cumbersome and expensive follow-up imaging in those with benign disease. (ii) To exclude cortisol excess, a 1 mg overnight dexamethasone suppression test should be performed (applying a cut-off value of serum cortisol ≤50 nmol/L (1.8 µg/dL)). (iii) For patients without clinical signs of overt Cushing's syndrome but serum cortisol levels post 1 mg dexamethasone >138 nmol/L (>5 µg/dL), we propose the term 'autonomous cortisol secretion'. (iv) All patients with '(possible) autonomous cortisol' secretion should be screened for hypertension and type 2 diabetes mellitus, to ensure these are appropriately treated. (v) Surgical treatment should be considered in an individualized approach in patients with 'autonomous cortisol secretion' who also have comorbidities that are potentially related to cortisol excess. (vi) In principle, the appropriateness of surgical intervention should be guided by the likelihood of malignancy, the presence and degree of hormone excess, age, general health and patient preference. (vii) Surgery is not usually indicated in patients www.eje-online.org European Journal of Endocrinology175:2 G2 Clinical Practice Guideline M Fassnacht and others ESE and ENSAT guideline on adrenal incidentalomawith an asymptomatic, nonfunctioning unilateral adrenal mass and obvious benign features on imaging studies. We provide guidance on which surgical approach should be considered for adrenal masses with radiological findings suspicious of malignancy. Furthermore, we offer recommendations for the follow-up of patients with adrenal incidentaloma who do not undergo adrenal surgery, for those with bilateral incidentalomas, for patients with extra-adrenal malignancy and adrenal masses and for young and elderly patients with adrenal inciden...

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Section: Surgical Approach: Open Vs Minimally Invasive Adrenalectomy mentioning

confidence: 99%

Section: Perioperative Mortality and Morbiditymentioning

confidence: 99%

Section: Recurrence-free and Overall Survivalmentioning

confidence: 99%

Section: Reasoningmentioning

confidence: 99%

See 2 more Smart Citations

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Fassnacht

Arlt

Bancos

et al. 2016

European Journal of Endocrinology

1,299

1,571

View full text Add to dashboard Cite

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“…This technique was described for the first time by Gagner in 1992 [1] and in the past years several studies have shown the advantages of laparoscopic approach [2] with decrease of the perioperative morbidity, lower complication rates, less operative blood loss, less postoperative pain and shorter hospital stay compared with open adrenalectomy [3]. On the contrary there are several doubts about laparoscopic approach in case of adrenocortical carcinoma [4,5]. However, laparoscopic surgery is more difficult to learn and requires different psychomotor skills than open laparotomy.…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional (3D) versus two-dimensional (2D) laparoscopic adrenalectomy: A case-control study

Agrusa

Buono

Chianetta

et al. 2016

International Journal of Surgery

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a b s t r a c tIntroduction: Laparoscopic adrenalectomy is today considered the gold standard of treatment for adrenal tumors. The development of high definition cameras does not eliminate the major limitation of twodimensional (2D) laparoscopy: lack of depth perception and loss of spatial orientation. Treedimensional (3D) HD laparoscopy was developed as an alternative to conventional 2D laparoscopy. Methods: We report our experience with use of 3D vision system for laparoscopic adrenalectomy. Between January 2009 and March 2015 we performed a total of 52 laparoscopic adrenalectomies. In this case-control study we considered 13 laparoscopic adrenalectomies performed with three-dimensional (3D) vision system as case group. The last 26 procedures made with two-dimensional (2D) HD laparoscopic system represented the control group. We considered primary end-points: operative time, intraoperative complications and conversion rate. We evaluated also quality of depth perception and surgical strain. Results: Although the operative time for the entire surgical procedure was shorter in 3D group, there were no significant differences. The surgeon experienced better depth perception with 3D system and subjectively reported less strain using 3D vision system. Residents and medical students confirmed these data on surgical outcome. Conclusion: 3D system vision does not seem to influence the operative time of laparoscopic adrenalectomy performed by experienced surgeon because the surgical technique request simple tasks. We obtain the better visualization in depth perception with effect on surgical precision. Comparative studies are necessary to verify if 3D can reduce perioperative complication with similar operative time.

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Malignant Tumors of the Adrenal Gland

Lee¹,

Habra²,

Campbell³

2022

Holland‐Frei Cancer Medicine

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Overview Optimal evaluation and treatment of malignant or potentially malignant adrenal tumors including pheochromocytoma/paraganglioma and adrenal cortical carcinoma can be complex. It requires appropriate diagnostic imaging and endocrine hormone evaluation, and benefits from expert multidisciplinary coordination, by medical oncologists, endocrinologists, and surgeons, as well as additional specialists, for example genetic counselors. Recent advances in diagnostic imaging, including functional imaging such as PET, have facilitated early detection and diagnosis, enhanced the accuracy of staging, and improved treatment planning. Good‐risk patients with resectable localized, recurrent, or limited metastatic disease are usually recommended to undergo either minimally invasive or open surgery. Advances in minimally invasive and open surgical techniques have improved surgical outcomes. There is no defined role for adjuvant therapy following resection of pheochromocytoma/paraganglioma. Adjuvant therapy for patients with adrenal cortical carcinoma, most commonly single‐agent mitotane, is considered selectively. Systemic treatment options for patients with locally recurrent, unresectable, or metastatic malignant adrenal carcinoma include targeted treatments for patients with metastatic pheochromocytoma/paraganglioma, and combination chemotherapy with or without mitotane for patients with adrenal cortical carcinoma. Radiation therapy for patients with malignant adrenal tumors of either histology is also employed selectively. Emerging genetic and molecular data, as well as clinical trials, increasingly inform treatment strategies and choice of systemic therapy.

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Open versus endoscopic adrenalectomy in the treatment of localized (stage I/II) adrenocortical carcinoma: Results of a multiinstitutional Italian survey

Cited by 114 publications

References 23 publications

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Three-dimensional (3D) versus two-dimensional (2D) laparoscopic adrenalectomy: A case-control study

Malignant Tumors of the Adrenal Gland

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