Simultaneous Bilateral Laparoscopic Adrenalectomy for Adrenal Metastases of Renal Cell Carcinoma: A Case Report

Nouralizadeh, Akbar; Afyouni, Amir; Shakiba, Behnam; Radhi, Fahad Khalid

doi:10.1089/cren.2017.0062

Cited by 9 publications

(8 citation statements)

References 12 publications

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“…Surgical resection of metastases is the only therapeutic option for these patients. Both bilateral adrenalectomies and total adrenalectomy on one side and partial adrenalectomy on the contralateral side to preserve adrenal hormonal function were reported (23,24).…”

Section: Adrenal Metastasis or Malignanciesmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Differential diagnosis, investigation and therapy of bilateral adrenal incidentalomas

Bourdeau

Ghorayeb

Gagnon

et al. 2018

European Journal of Endocrinology

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The investigation and management of unilateral adrenal incidentalomas have been extensively considered in the last decades. While bilateral adrenal incidentalomas represent about 15% of adrenal incidentalomas (AIs), they have been less frequently discussed. The differential diagnosis of bilateral incidentalomas includes metastasis, primary bilateral macronodular adrenal hyperplasia and bilateral cortical adenomas. Less frequent etiologies are bilateral pheochromocytomas, congenital adrenal hyperplasia (CAH), Cushing's disease or ectopic ACTH secretion with secondary bilateral adrenal hyperplasia, primary malignancies, myelolipomas, infections or hemorrhage. The investigation of bilateral incidentalomas includes the same hormonal evaluation to exclude excess hormone secretion as recommended in unilateral AI, but diagnosis of CAH and adrenal insufficiency should also be excluded. This review is focused on the differential diagnosis, investigation and treatment of bilateral AIs.

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Section: Adrenal Metastasis or Malignanciesmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Differential diagnosis, investigation and therapy of bilateral adrenal incidentalomas

Bourdeau

Ghorayeb

Gagnon

et al. 2018

European Journal of Endocrinology

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“…Gokcen et al [15] 54/M L Syn 6 7 14 Lt Rad Nx Bil Adnx --7. Nouralizadeh et al [8] 64/F L Met (7y after Sur) -4 4 Bil Adnx --8. Pandey et al [9] 60F…”

Section: Discussionmentioning

confidence: 98%

“…Nevertheless, with the advance of surgical technology, adrenalectomy with the aim of prolonging survival has been regarded as the standard of care in patients with adrenal metastasis [7] . Laparoscopic adrenalectomy has advantages such as rapid recovery, less pain, better cosmetic results, lower percentage of incision hernia, and rapid return to possible systemic therapy for metastatic diseases [8] . Therefore, laparoscopic adrenalectomy is the preferred treatment for adrenal gland metastasis in RCC patients.…”

Section: Discussionmentioning

confidence: 99%

Bilateral adrenal metastasis of renal cell carcinoma 4 years after radical nephrectomy

Li¹,

Ji²,

Wang³

et al. 2021

Medicine

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Rationale: Renal cell carcinoma (RCC) almost metastasizes to every organ, the possibility of adrenal metastasis is relatively low in patients that have undergone radical nephrectomy, only a few cases of bilateral adrenal metastasis are reported on literature. Although surgical treatment of metastases from RCC is preferred and contributes to the rate of survival, it is considered challenging to manage such cases due to the rarity of bilateral metastasis to the adrenal glands.Patient concerns: A 64-year-old Manchus female presented with an incidental ultrasonic finding of a left adrenal mass 4 years after radical nephrectomy for left renal cell carcinoma.Diagnosis: Abdominal contrast enhanced CT scan revealed bilateral adrenal masses, suggesting metastatic lesion. Examinations indicated neither local recurrence nor distant metastasis anywhere have been detected by whole body Positron Emission Tomography/Computed Tomography (PET/CT) scan except high radioactive uptake in bilateral adrenal glands.Interventions: Metachronous bilateral adrenalectomy was taken and laparoscopic right adrenalectomy was first performed. She was discharged home on third postoperative day. Pathological examination revealed metastatic renal cell carcinoma. Two months later she was performed laparoscopic left adrenalectomy.Outcomes: The patient healed without obvious complications and no tumor recurrence.Lessons: Bilateral metastatic adrenal recurrence from RCC is very rare. Early diagnosis of adrenal metastasis is challenging because they are usually silent both anatomically and functionally. Surgical intervention is a wise option for these patients that may improve survival, and metachronous bilateral adrenalectomy is proved to be safe and effective.Abbreviations: CT = Computed tomography, PET/CT = Positron emission tomography/computed tomography, RCC = Renal cell carcinoma, SUV = Standard uptake value.

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“…Изолированные синхронные билатеральные метастазы в надпочечные железы являются крайне редкой ситуацией. В мировой литературе преимущественно представлены единичные клинические сообщения о таких пациентах [5][6][7][8][9]. Лечение данных больных включает билатеральную адреналэктомию или резекцию надпочечников [10][11][12][13].…”

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“…Суммарный опыт хирургического лечения синхронных метастазов ПКР в оба надпочечника весьма небольшой. К настоящему времени описано менее тридцати подобных наблюдений [5][6][7][8][9]. Клинические ситуации у этих пациентов в большинстве случаев являются весьма сложными, как в отношении хирургической тактики, выбора техники оперативного вмешательства, так и с точки зрения послеоперационной курации данных больных.…”

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Synchronous Bilateral Metastases of Renal Cell Carcinoma

Balarabe¹,

Shchukin²

2021

Ukr. ž. med. bìol. sportu

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Adrenal metastases of renal cell carcinoma represent one of the forms of distant spread of this tumor. The world medical literature has isolated clinical reports about such cases. Treatment for these patients includes bilateral adrenalectomy or adrenal resection. These techniques are often complicated by adrenal insufficiency, which can lead to sudden death of the patient even with substitution therapy. The aim. Therefore, nephrectomy with ipsilateral adrenalectomy and subsequent dynamic observation of metastasis in the contralateral adrenal gland are used in some patients. Material and methods. The study included 4 patients with this pathology, who were treated and observed in Municipal Non-Commercial Enterprise of Kharkiv Regional Council “Regional Medical Clinical Center of Urology and Nephrology named after V. I. Shapoval” from 2010 to 2020. The studied sample was dominated by men (3: 1). The average age of the patients was 57.8±5.3 years. The blood cortisol level in all patients before the operation was within the normal range. The patients also did not show a tendency to arterial hypotension. The average size of renal tumors reached 8.7±2.8 cm. The stage of the neoplasm was assessed as pT3a in 3 out of 4 observation cases. At the same time, there was invasion only in the perinephric fat. The renal tumor did not penetrate into the venous system in any of the cases. The histological structure of neoplasms in all patients was represented by clear-cell renal cell carcinoma. The size of adrenal metastases averaged 38.5±11.9 mm (from 24 to 56 mm). Left-sided metastases on average did not exceed 43±12.9 mm, while right-sided metastases were 34±10.6 mm. Macroscopic spread of both adrenal tumors into the venous system took place in one case (on the left - into the main renal vein, on the right - into the inferior vena cava). The average follow-up period in the entire group averaged 21.8±17.6 months. Surgical treatment included nephrectomy and bilateral adrenalectomy or adrenalectomy with adrenal resection. All patients underwent simultaneous removal of the kidney and metastases of both adrenal glands. Operations were performed using the chevron laparotomic approach. After surgery, three patients received systemic therapy (sutent, pazopanib, axitinib). Results and discussion. The mean operation time was 195±19.1 min, and the volume of blood loss was 800±81.6 ml. Complications of Clavien-Dindo grade was ≥III, and we did not record perioperative mortality in our study. Despite hormone replacement therapy, three patients had crises of Addison's disease at different times, which led one patient to death. The examination protocol included an ultrasound scan every 3 months, and multislice computed tomography of the lungs and abdominal organs every 6 months, a study of the blood cortisol level once every 2-3 weeks. Targeted therapy was used in three patients after surgery, but two of them died from cancer progression, and one patient stayed alive with tumor progression within 48 months. Conclusion. Synchronous bilateral metastases of renal cell carcinoma to the adrenal glands are not only a difficult surgical problem, but also a major therapeutic problem. Our study has demonstrated the efficacy and safety of the synchronous surgical approach in these patients. The prognosis in patients of this group is predominantly poor, but in some patients, long-term survival is possible. The question of the possibility of targeted therapy on the background of adrenal deprivation requires further study

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Simultaneous Bilateral Laparoscopic Adrenalectomy for Adrenal Metastases of Renal Cell Carcinoma: A Case Report

Cited by 9 publications

References 12 publications

MANAGEMENT OF ENDOCRINE DISEASE: Differential diagnosis, investigation and therapy of bilateral adrenal incidentalomas

MANAGEMENT OF ENDOCRINE DISEASE: Differential diagnosis, investigation and therapy of bilateral adrenal incidentalomas

Bilateral adrenal metastasis of renal cell carcinoma 4 years after radical nephrectomy

Synchronous Bilateral Metastases of Renal Cell Carcinoma

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