Annals of Surgical Oncology

, Volume 9, Issue 5, pp 480–485 | Cite as

Laparoscopic resection of large adrenal tumors

  • Dougald C. MacGillivray
  • Giles F. Whalen
  • Carl D. Malchoff
  • Daniel S. Oppenheim
  • Steven J. Shichman
Original Articles

Abstract

Background

The maximum size of adrenal tumors that should be removed with a laparoscopic approach is controversial. It has been suggested that laparoscopic adrenalectomy is appropriate only for adrenal tumors <6 cm in size. We report our experience with laparoscopic adrenalectomy in patients with adrenal tumors of ≥6 cm compared with patients with smaller tumors.

Methods

We retrospectively reviewed a consecutive series of patients who had a laparoscopic adrenalectomy. Patients were considered candidates for laparoscopic adrenalectomy if their computed tomography (CT) scan showed a well-encapsulated tumor confined to the adrenal gland.

Results

Sixty laparoscopic adrenalectomies were performed in 53 patients. Twelve of the adrenalectomies (20%) were for tumors that were ≥6 cm (median, 8 cm; range, 6 to 12 cm). There have been no local or regional recurrences but one patient with adrenocortical carcinoma developed pulmonary metastases. When the 12 patients with large tumors were compared with the 36 patients with tumors <6 cm, the median operative time (190 vs. 180 minutes;P=.32), operative blood loss (100 vs. 50 mL;P=.53), and postoperative hospital stay (2 vs. 2 days;P=1.0) were similar.

Conclusions

The size of an adrenal tumor should not be the primary factor in determining whether a laparoscopic adrenalectomy should be performed. Large adrenal tumors that are confined to the adrenal gland on CT can be removed with a laparoscopic approach.

Key Words

Laparoscopic adrenalectomy Adrenal tumors Pheochromocytoma Cushing’s syndrome 

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References

  1. 1.
    Prinz RA. A comparison of laparoscopic and open adrenalectomies.Arch Surg 1995;130:489–94.PubMedGoogle Scholar
  2. 2.
    MacGillivray DC, Shichman SJ, Ferrer FA, Malchoff CD. A comparison of open vs laparoscopic adrenalectomy.Surg Endosc 1996;10:987–90.PubMedCrossRefGoogle Scholar
  3. 3.
    Brunt LM, Doherty GM, Norton JA, Soper NJ, Quasebbbarth MA. Moley JF. Laparoscopic adrenalectomy compared to open adrenalectomy for benign adrenal neoplasms.J. Am Coll Surg 1996; 183:1–10.PubMedGoogle Scholar
  4. 4.
    Thompson GB, Grant CS, van Heerden JA, et al. Laparoscopic versus open posterior adrenalectomy: a case-control study of 100 patients.Surgery 1997;6:132–136.Google Scholar
  5. 5.
    Jossart GH, Burpee SE, Gagner M. Sutgery of the adrenal glands.Endocrinol Metab Clin North Am 2000;29:57–68.PubMedCrossRefGoogle Scholar
  6. 6.
    Wells SA, Merke DP, Cutler GB, Norton JA, Lacroix A. The role of laparoscopic surgery in adrenal disease.J Clin endocrinol Metab 1998;83:3041–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Barresi RV, Prinz RA. Laparoscopic adrenalectomy.Arch Surg 1999;134:212–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Barnett CC, Varma DV, El-Naggar AK, et al. Limitations of size as a criterion in the evaluation of adrenal tumors.Surgery 2000; 128:973–83.PubMedCrossRefGoogle Scholar
  9. 9.
    Gagner M, Pomp A, Heniford BT, Pharand D, Lacroix A. Laparoscopic adrenalectomy: lessons learned from 100 consecutive procedures.Ann Surg 1997;3:238–47.CrossRefGoogle Scholar
  10. 10.
    Henry JF, Defechereux T, Gramatica L, Raffaelli M. Should laparoscopic approach be proposed for large and/or potentially malignant adrenal tumors?Langenbecks Arch Surg 1999;384:366–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Heniford BT, Arca MJ, Walsh RM, Gill IS. Laparoscopic adrenalectomy for cancer.Semin Surg Oncol 1999;16:293–306.PubMedCrossRefGoogle Scholar
  12. 12.
    Hobart MG, Inderbir GS, Schweizer D, Sung GT, Bravo EL. Laparoscopic adrenalectomy for large-volume (≥5 cm) adrenal masses.J Endourol 2000;14:149–54.PubMedCrossRefGoogle Scholar
  13. 13.
    Henry JF, Defechereux T, Raffaelli M, Lubrano D, Gramatica L. Complications of laparoscopic adrenalectomy: results of 169 consecutive proceduresWorld J Surg 2000;24:1342–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Gagner M, Lacroix A, Bolte E, Pomp A. Laparoscopic adrenalectomy: the importance of a flank approach in the lateral decubitus position.Surg Endosc 1994;8:135–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Shichman SJ, Herndon CD, Sousa RE, et al. Lateral transperitoneal laparoscopic adrenalectomy.World J Urol 1999;17:48–53.PubMedCrossRefGoogle Scholar
  16. 16.
    Schell SR, Talamini MA, Udelsman R. Laparoscopic adrenalectomy for nonmalignant disease: improved safety, morbidity, and cost-effectiveness.Surg Endosc 1999;13:30–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Copeland PM. The incidentally discovered adrenal mass.Ann Surg 1984;199:116–22.PubMedCrossRefGoogle Scholar
  18. 18.
    Kloos RT, Gross MD, Francis IR, Korobkin M, Shapiro B. Incidentally discovered adrenal masses.Endocr Rev 1995;16:460–84.PubMedCrossRefGoogle Scholar
  19. 19.
    Wajchenberg BL, Pereira MAA, Medonca BB et al. Adrenocortical carcinoma: clinical and laboratory observations.Cancer 2000; 88:711–36.PubMedCrossRefGoogle Scholar
  20. 20.
    Khafagi FA, Gross MD, Shapiro B, Glazer GM, Francis I, Thompson NW. Clinical significance of the large adrenal mass.Br J Surg 1991;78:828–33.PubMedGoogle Scholar
  21. 21.
    Terzolo M, Ali A, Osella G, Mazza E. Prevalence of adrenal carcinoma among incidentally discovered adrenal masses.Arch Surg 1997;132:914–9.PubMedGoogle Scholar
  22. 22.
    Bernini GP, Miccoli P, Moretti A, Vivaldi MS, Jacconi P, Salvetti A. Sixty adrenal masses of large dimension: hormonal and morphologic evaluation.Urology 1998;51:920–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Suzuki K, Ushiyama T, Mugiya S, Kageyama S, Sais K, Fujita K. Hazards of laparoscopic adrenalectomy in patients with adrenal malignancy.J Urol 1997;158:2227.PubMedCrossRefGoogle Scholar
  24. 24.
    Hofle G, Gasser RW, Lhotta K, Janetschek G, Kreczy A, Finkenstedt G. Adrenocortical carcinoma evolving after diagnosis of preclinical Cushing’s syndrome in an adrenal incidentaloma. A case report.Horm Res 1998;50:237–42.PubMedCrossRefGoogle Scholar
  25. 25.
    Deckers S, Derdelinckx L, Col V, Hamels J, Maiter D. Peritoneal carcinomatosis following laparoscopic resection of an adrenocortical tumor causing primary hyperaldosteronism.Horm Res 1999; 52:97–100.PubMedCrossRefGoogle Scholar
  26. 26.
    Foxius A, Ramboux A, Lefebvre Y, Broze B, Hamels J, Squifflet JP. Hazards of laparoscopic adrenalectomy for Conn’s adenoma: when enthusiasm turns to tragedy.Surg Endosc 1999; 13:715–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Bonjer HJ, Sorm V, Berends FJ et al. Endoscopic retroperitoneal adrenalectomy: lessons learned from 111 consecutive cases.Ann Surg 2000;232:796–803.PubMedCrossRefGoogle Scholar
  28. 28.
    Iino K, Oki Y, Sasano H. A case of adrenocortical carcinoma associated with recurrence after laparoscopic surgery.Clin Endocrinol 2000;53:243–8.CrossRefGoogle Scholar
  29. 29.
    Schulick R, Brennan MF. Long-term survival after complete resection and repeat resection in patients with adrenocortical carcinoma.Ann Surg Oncol 1999;6:719–26.PubMedCrossRefGoogle Scholar
  30. 30.
    Crucitti F, Bellantone R, Ferrante A, Boscherini M, Crucitti P. The Italian Registry for Adrenal Cortical Carcinoma: analysis of a multiinstitutional series of 129 patients. The ACC Italian Registry Study Group.Surgery 1996;119:161–70.PubMedCrossRefGoogle Scholar
  31. 31.
    Harrison LE, Gaudin PB, Brennan MF. Pathologic features of prognostic significance for adrenocortical carcinoma after curative resection.Arch Surg 1999;134:181–5.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2002

Authors and Affiliations

  • Dougald C. MacGillivray
    • 1
  • Giles F. Whalen
    • 3
  • Carl D. Malchoff
    • 3
  • Daniel S. Oppenheim
    • 2
  • Steven J. Shichman
    • 3
  1. 1.Department of Surgery, Division of Surgical OncologyMaine Medical CenterPortland
  2. 2.Department of Medicine, Division of EndocrinologyMaine Medical CenterPortland
  3. 3.Department of SurgeryUniversity of Connecticut Health CenterFarmington
  4. 4.Maine Surgical Care GroupPortland

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