Surgical management of large adrenal tumours: the University of Miami experience using liver transplantation techniques

Abstract

OBJECTIVE To report our experience in the surgical management of patients with large adrenal masses and describe the key steps in performing radical resections, which are especially demanding where thrombi extend into the inferior vena cava (IVC). PATIENTS AND METHODS From 2003 to 2007, 14 patients presented with large adrenal mass, and underwent surgical extirpation. In five patients thrombi extended into the IVC, causing Budd–Chiari syndrome in one. RESULTS The median (range) patient age was 48 (40–58) years. The excision was radical with negative tumour margins in all cases. Cardiopulmonary bypass (CPB) was required in one case with adherent intra‐atrial thrombus. The mean blood loss was 500 (250–1500) mL except in the patient who required CPB. Morbidity included pleural effusion (three patients) and postoperative pneumonia (two), which responded to conservative management. All patients were alive and free of disease at a median follow‐up of 12 (5–42) months. CONCLUSIONS Surgical extirpation of large adrenal masses requires technical experience to optimize outcome. Total tumour excision is the only therapeutic option in such cases and provides acceptable results in survival and quality of life.

Transplantation techniques for the resection of renal cell carcinoma with tumor thrombus: A technical description and review

“…Adrenocortical carcinoma (ACC) and upper tract urothelial carcinoma are also known to involve the IVC. In 2008, Delis et al reported on the experience at UM/JMH managing 14 patients with extensive ACC [32]. In total, 5 (35.7%) patients had tumor invading the IVC and were successfully treated with tumor thrombectomy.…”

Resection of Large Urological Tumors With or Without Inferior Vena Cava Extension in Jehova's Witnesses

“…Renal and adrenal tumors infrequently extend into the inferior vena cava (IVC) (1,2). Unfortunately, surgery remains the only potential cure for these patients (3,4). Most surgeons would agree that this type of surgery is complex and require an excellent understanding of the anatomy (4,5).…”

“…Unfortunately, surgery remains the only potential cure for these patients (3,4). Most surgeons would agree that this type of surgery is complex and require an excellent understanding of the anatomy (4,5). The surgical technique has to provide adequate exposure and optimal vascular control to avoid perioperative complications, including massive hemorrhage and death.…”

Surgical Resection of Giant Pheochromocytomas Arising Behind the Retrohepatic Inferior Vena Cava

“…However, in cases where the tumors are considered to be unresectable in situ, such as when tumor invasion to the IVC or the liver is evident, or the tumor is located between the IVC and the portal triad, ex vivo resection of the tumor and autotransplantation of the liver is an option (10). Increased surgical experience with liver transplantation has enabled surgeons to perform such a complex procedure (11,12). Using the TTIVC technique, we believe that venous bypass is not necessary because venous flow of the liver into the IVC is completely preserved during TTIVC.…”