Results of Laparoscopic Adrenalectomy for Large and Potentially Malignant Tumors

Abstract

Endoscopic adrenalectomy is the procedure of choice for patients with small functioning adrenal tumors. For most surgeons invasive adrenal carcinoma is an absolute contraindication for laparoscopic adrenalectomy (LA). Whether LA should be proposed for large (> 6 cm), potentially malignant tumors is questionable. The aim of this study was to evaluate the risks and outcome of LA performed in our department in patients with tumors > 6 cm and potentially malignant. We performed a retrospective study of 216 patients who underwent 233 LAs in our department from 1994 to 2000. We selected 19 patients with a tumor > 6 cm and potentially malignant: 8 nonfunctional tumors, 4 cortisol-secreting tumors, 1 virilizing tumor, and 6 pheochromocytomas. In none of these patients did preoperative investigations demonstrated invasive carcinoma. The median tumor size was 70 mm. LA was performed by a transperitoneal flank approach. Conversion to open adrenalectomy was performed in two patients owing to intraoperative evidence of invasive carcinoma. The median operating time was 150 minutes (range 95-240 minutes). Capsular disruption occurred during the dissection of two pheochromocytomas. There was no postoperative morbidity. Six patients had an adrenocortical carcinoma on pathologic diagnosis: three of the eight nonfunctional tumors, one of the four cortisol-secreting tumors, and one virilizing tumor. One patient presented with liver metastases 6 months after surgery and died. The five other patients are disease-free with a follow-up ranging from 8 to 83 months. The 13 patients with benign lesions (6 cortical adenomas, 1 ganglioneuroma, 6 pheochromocytomas) are disease-free with a median follow-up of 47 months (range 10-81 months). In experienced hands LA can be proposed for large, potentially malignant tumors. Conversion to open adrenalectomy should be performed if local invasion is observed during surgery. At present the risk of intraabdominal recurrence is unknown.

SBRT: A viable option for treating adrenal gland metastases

“…13 However, laparoscopic procedures are contraindicated in lesions larger than 6 cm. 14 Overall, the rate of major complication after surgery is around 1.8%. 15 Recently adrenal gland metastases of 46%, representing a total of 655 patients.…”

Molecular and Therapeutic Advances in the Diagnosis and Management of Malignant Pheochromocytomas and Paragangliomas

“…The likelihood of tumor response is predicted by high tumor uptake of these agents on pretreatment scintigraphy. Symptomatic relief and tumor stabilization have been reported, and the results reported for 177 Lu-DOTATATE in metastatic NETs are encouraging in terms of tumor regression [197]. Kwekkeboom et al [196] analyzed the response to 177 Lu-DOTATATE in 301 patients with NETs at 3 months following treatment.…”

“…Symptomatic relief and tumor stabilization have been reported, and the results reported for 177 Lu-DOTATATE in metastatic NETs are encouraging in terms of tumor regression [197]. Kwekkeboom et al [196] analyzed the response to 177 Lu-DOTATATE in 301 patients with NETs at 3 months following treatment. They reported an overall objective tumor response rate, including complete remission, partial remission, and minor response of 46%, with high uptake on diagnostic Octreoscan imaging strongly predictive of tumor remission.…”

“…For cases in which locoregional infiltration is diagnosed preoperatively or there is a high suspicion of malignancy, the goal of surgery remains complete surgical excision, which may be best facilitated with an open surgical approach [177]. This approach may require extensive resection of adjacent tissues and involved organs (pancreas, spleen, liver, kidney, vena cava).…”

“…This approach may require extensive resection of adjacent tissues and involved organs (pancreas, spleen, liver, kidney, vena cava). It is reasonable to initially explore these patients laparoscopically/retroperitoneoscopically; however, local invasion usually mandates conversion to open surgery [177]. Intraoperative use of 123 I-MIBG and a ␥-probe may be helpful in localizing metastatic deposits or identifying residual disease when attempting complete excision.…”