Outcomes and timing for intervention of partial adrenalectomy in patients with a solitary adrenal remnant and history of bilateral phaeochromocytomas

Abstract

Summary Objective To evaluate the outcomes and timing of intervention for adrenal sparing surgery in patients left with a solitary adrenal remnant after bilateral adrenal surgeries. Subjects/Patients and Methods Patients were included in the study if they had undergone bilateral adrenal surgery as a treatment for pheochromocytoma and were left with a solitary adrenal remnant. Perioperative, functional, and oncologic outcomes were evaluated on 21 patients that met the inclusion criteria. Results There was minimal perioperative morbidity and no perioperative mortality. After a median follow up of 21 months (range 3–143) there were two cases of persistent disease. Ten patients (48%) required steroid supplementation upon discharge with 4 subsequently discontinuing steroid supplementation. Patients were more likely to require steroid supplementation postoperatively if they underwent simultaneous adrenalectomy and contralateral partial adrenalectomy, rather than staged procedures (86% versus 40%, p=0.02). Additionally, patients who underwent surgery for tumors greater than 4 cm were more likely to require long-term steroids than patients who underwent surgery for lesions less than 4 cm (75% versus 18%, p=0.05). Conclusions Patients left with a solitary adrenal remnant after bilateral adrenal surgery have low surgical morbidity, reasonable functional outcomes and low rates of recurrence at an intermediate follow-up period. A staged approach may decrease the immediate postoperative need for steroids, and intervention before the largest tumor reaches 4 cm may decrease the rate of long-term steroid dependence.

Robot-Assisted Laparoscopic Partial Adrenalectomy for Pheochromocytoma: The National Cancer Institute Technique

“…Finally, of four patients with a solitary adrenal gland, three patients did not require long-term treatment with steroid replacement after RALPA, indicating that the residual adrenal gland after RALPA was able to provide physiologic levels of endogenous steroids. These results are consistent with the findings of Sanford et al, evaluating outcomes of patients requiring adrenal surgery on a solitary adrenal [22]. Given the risks associated with bilateral adrenalectomy and uncertain dosing with exogenous steroids, it appears that adrenal-sparing surgery offers these patients a significant benefit.…”

Perioperative, Functional, and Oncologic Outcomes of Partial Adrenalectomy for Multiple Ipsilateral Pheochromocytomas

“…3,4 A recent review of 417 patients undergoing PA found that the procedure was associated with minimal morbidity, a 3% recurrence rate, and the freedom from steroid replacement in 90% of patients. 5 It has been demonstrated that even the majority of patients with a solitary adrenal gland maintain independence from steroid use following PA. 6 To our knowledge, there is no literature on PA performed for synchronous multiple ipsilateral pheochromocytomas in a single setting. In this study, we report the perioperative, functional, and short-term oncologic outcomes of PA for multiple pheochromocytomas.…”

Pheochromocytoma in Urologic Practice

“…Nevertheless, because of a higher likelihood for bilaterality and genetic causes, the optimal management of adrenal pheochromocytoma in all-comers should consider adrenal preservation when technically feasible [54]. For patients with bilateral adrenal pheochromocytomas, a staged approach is recommended; moreover, intervention should take place before the tumors reach 4cm to allow for the best functional outcomes [55]. Partial adrenalectomy can be performed using pure laparoscopy or with robotic assistance [53, 56], and results in reasonable outcomes even in those patients with a solitary adrenal gland [57].…”