World Journal of Surgery

, Volume 30, Issue 5, pp 893–898 | Cite as

Long-term Outcome following Laparoscopic Adrenalectomy for Large Solid Adrenal Cortex Tumors

  • F. Fausto Palazzo
  • Frederic Sebag
  • Mauricio Sierra
  • Giuseppe Ippolito
  • Philippe Souteyrand
  • Jean-François Henry
Article

Abstract

Introduction

Laparoscopic adrenalectomy (LA) is the procedure of choice for small benign adrenal tumors. In the absence of local invasion or metastases, the preoperative diagnosis of an adrenocortical carcinoma (ACC) is difficult, often leaving size as the principal predictor of malignancy. Large tumors are resectable laparoscopically, but the long-term outcome and therefore appropriateness of LA for cortical tumors > 6 cm is not known.

Methods

We reviewed the LA experience in our institution since its introduction in June 1994. Patients who underwent LA for solid cortical tumors ≥ 60 mm in diameter without preoperative or intraoperative evidence of malignancy were reviewed. Follow-up data, including clinical examination, biochemical analysis, and repeat scans, were reviewed for evidence of local or systemic recurrent disease.

Results

Between 1994 and 2004 a total of 462 adrenalectomies were performed, 391 of which were done laparoscopically. Among them, 19 were solid cortical tumors ≥ 60 mm in diameter with no overt malignant preoperative or intraoperative characteristics: 9 nonsecreting tumors, 8 Cushing’s syndrome tumors (including 2 virilizing variants), 1 virilizing tumor, and 1 aldosteronoma. The mean age of the patients was 49.9 years (range 22–77 years), and the mean tumor size was 69.0 mm (range 60–80 mm). Histology confirmed a cortical adenoma in eight patients, malignant tumors in three, and indeterminate tumors in eight. The mean follow-up was 34 months (range 4–108 months). Two patients died of systemic recurrent disease (liver metastases) at 10 and 19 months, respectively, following surgery; two other patients died 12 and 21 months, respectively following surgery owing to unrelated cardiovascular and cerebrovascular pathology. One patient underwent surgery for local recurrence 54 months after primary surgery; the remaining 14 patients are well with no clinical or radiologic evidence of recurrent disease.

Conclusions

Laparoscopic adrenalectomy for large solid cortical tumors without pre- or intraoperative evidence of malignancy is not contraindicated, and it is unlikely to have a deleterious effect on long-term outcome. Each case should be considered individually. We provide an algorithm for the approach to adrenocortical tumors ≥ 6 cm.

References

  1. 1.
    Gagner M, Lacroix A, Bolte E. Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 1992;327:1033PubMedCrossRefGoogle Scholar
  2. 2.
    Imai T, Kikumori T, Ohiwa M, et al. A case-controlled study of laparoscopic compared with open lateral adrenalectomy. Am J Surg 1999;178:50–53CrossRefPubMedGoogle Scholar
  3. 3.
    Dudley NE, Harrison BJ. Comparison of open posterior versus transperitoneal laparoscopic adrenalectomy. Br J Surg 1999;86:656–660CrossRefPubMedGoogle 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;122:1132–1136CrossRefPubMedGoogle Scholar
  5. 5.
    Assalia A, Gagner M. Laparoscopic adrenalectomy. Br J Surg 2004;91:1259–1274CrossRefPubMedGoogle Scholar
  6. 6.
    Kebebew E, Siperstein AE, Duh QY. Laparoscopic adrenalectomy: the optimal surgical approach. J Laparoendosc Adv Surg Tech A 2001;11:409–413CrossRefPubMedGoogle Scholar
  7. 7.
    Gagner M, Pomp A, Heniford BT, et al. Laparoscopic adrenalectomy: lessons learned from 100 consecutive procedures. Ann Surg 1997;226:238–246CrossRefPubMedGoogle Scholar
  8. 8.
    MacGillivray DC, Whalen GF, Malchoff CD, et al. Laparoscopic resection of large adrenal tumors. Ann Surg Oncol 2002;9:480–485CrossRefPubMedGoogle Scholar
  9. 9.
    Kebebew E, Siperstein AE, Clark OH, et al. Results of laparoscopic adrenalectomy for suspected and unsuspected malignant adrenal neoplasms. Arch Surg 2002;137:948–951CrossRefPubMedGoogle Scholar
  10. 10.
    Deckers S, Derdelinckx L, Col V, et al. Peritoneal carcinomatosis following laparoscopic resection of an adrenocortical tumor causing primary hyperaldosteronism. Horm Res 1999;52:97–100CrossRefPubMedGoogle Scholar
  11. 11.
    Foxius A, Ramboux A, Lefebvre Y, et al. Hazards of laparoscopic adrenalectomy for Conn’s adenoma: when enthusiasm turns to tragedy. Surg Endosc 1999;13:715–717CrossRefPubMedGoogle Scholar
  12. 12.
    Schell SR, Talamini MA, Udelsman R. Laparoscopic adrenalectomy for nonmalignant disease: improved safety, morbidity, and cost-effectiveness. Surg Endosc 1999;13:30–34CrossRefPubMedGoogle Scholar
  13. 13.
    Fassnacht M, Kenn W, Allolio B. Adrenal tumors: how to establish malignancy? J Endocrinol Invest 2004;27:387–399PubMedGoogle Scholar
  14. 14.
    Kumar R, Xiu Y, Yu JQ, et al. 18F-FDG PET in evaluation of adrenal lesions in patients with lung cancer. J Nucl Med 2004;45:2058–2062PubMedGoogle Scholar
  15. 15.
    Wells SA, Merke DP, Cutler GB Jr, et al. Therapeutic controversy: the role of laparoscopic surgery in adrenal disease. J Clin Endocrinol Metab 1998;83:3041–3049CrossRefPubMedGoogle Scholar
  16. 16.
    Ross NS, Aron DC. Hormonal evaluation of the patient with an incidentally discovered adrenal mass. N Engl J Med 1990;323:1401–1405PubMedCrossRefGoogle Scholar
  17. 17.
    Sidhu S, Sywak M, Robinson B, et al. Adrenocortical cancer: recent clinical and molecular advances. Curr Opin Oncol 2004;16:13–18CrossRefPubMedGoogle Scholar
  18. 18.
    Aubert S, Wacrenier A, Leroy X, et al. Weiss system revisited: a clinicopathologic and immunohistochemical study of 49 adrenocortical tumors. Am J Surg Pathol 2002;26:1612–1619CrossRefPubMedGoogle Scholar
  19. 19.
    Pohlink C, Tannapfe A, Eichfelf U, et al. Does tumor heterogeneity limit the use of the Weiss criteria in the evaluation of adrenocortical tumors? J Endocrinol Invest 2005;27:565–569Google Scholar
  20. 20.
    Stojadinovic A, Brennan MF, Hoos A, et al. Adrenocortical adenoma and carcinoma: histopathological and molecular comparative analysis. Mod Pathol 2003;16:742–751CrossRefPubMedGoogle Scholar
  21. 21.
    de Fraipont F, El Atifi M, Cherradi N, et al. Gene expression profiling of human adrenocortical tumors using complementary deoxyribonucleic acid microarrays identifies several candidate genes as markers of malignancy. J Clin Endocrinol Metab 2005;90:1819–1829CrossRefPubMedGoogle Scholar
  22. 22.
    Page DL, DeLellis RA, Hough AJ. Tumors of the adrenal. In Atlas of Tumor Pathology. Washington, DC, Armed Forces Institute of Pathology, 1986;1–106Google Scholar
  23. 23.
    Kloos RT, Gross MD, Francis IR, et al. Incidentally discovered adrenal masses. Endocr Rev 1995;16:460–484CrossRefPubMedGoogle Scholar
  24. 24.
    Barnett CC Jr, Varma DG, El-Naggar AK, et al. Limitations of size as a criterion in the evaluation of adrenal tumors. Surgery 2000;128:973–982CrossRefPubMedGoogle Scholar
  25. 25.
    Copeland PM. The incidentally discovered adrenal mass. Ann Surg 1984;199:116–122PubMedGoogle Scholar
  26. 26.
    Wajchenberg BL, Albergaria Pereira MA, Medonca BB, et al. Adrenocortical carcinoma: clinical and laboratory observations. Cancer 2000;88:711–736CrossRefPubMedGoogle Scholar
  27. 27.
    Schulick RD, Brennan MF. Long-term survival after complete resection and repeat resection in patients with adrenocortical carcinoma. Ann Surg Oncol 1999;6:719–726CrossRefPubMedGoogle Scholar
  28. 28.
    Dackiw AP, Lee JE, Gagel RF, et al. Adrenal cortical carcinoma. World J Surg 2001;25:914–926CrossRefPubMedGoogle Scholar
  29. 29.
    Walz MK, Petersenn S, Koch JA, et al. Endoscopic treatment of large primary adrenal tumors. Br J Surg 2005;92:719–726CrossRefPubMedGoogle Scholar
  30. 30.
    Ushiyama T, Suzuki K, Kageyama S, et al. A case of Cushing’s syndrome due to adrenocortical carcinoma with recurrence 19 months after laparoscopic adrenalectomy. J Urol 1997;157:2239CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2006

Authors and Affiliations

  • F. Fausto Palazzo
    • 1
  • Frederic Sebag
    • 1
  • Mauricio Sierra
    • 1
  • Giuseppe Ippolito
    • 1
  • Philippe Souteyrand
    • 1
  • Jean-François Henry
    • 1
  1. 1.Department of Endocrine SurgeryLa Timone University HospitalMarseilleFrance

Personalised recommendations