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Surgical Endoscopy

, Volume 22, Issue 3, pp 617–621 | Cite as

The role of laparoscopic adrenalectomy for adrenal tumours of 6 cm or greater

  • C. N. ParnabyEmail author
  • P. S. Chong
  • L. Chisholm
  • J. Farrow
  • J. M. Connell
  • P. J. O’ Dwyer
Article

Abstract

Background

Laparoscopic adrenalectomy (LA) has been shown to reduce hospital stay and morbidity when compared to open adrenalectomy (OA). It is uncertain if the laparoscopic resection of large (≥6 cm) potentially malignant adrenal tumours is appropriate due to concern over incomplete resection and local recurrence. The aim of the present study was to compare the outcomes of LA for tumours ≥6 cm with those < 6 cm.

Methods

Details of all patients referred with adrenal tumours between January 1999 and January 2006 had been recorded prospectively on a database. LA was performed using a lateral transabdominal approach. Contraindications to LA were local invasion requiring en bloc resection of adjacent organs or the requirement of additional open procedures.

Results

103 patients were referred for adrenal resection. Three with metastatic adrenal carcinoma and two with severe cardiorespiratory disease were deemed unsuitable for operation. One hundred and eleven adrenalectomies were performed: 101 LAs and 10 OAs. Thirty-nine LA were for tumours ≥6 cm while nine OA were for tumours ≥6 cm. There were no significant differences between the median total anaesthetic time, postoperative complications or postoperative stay for patients undergoing LA for tumours ≥6 cm versus tumours <6 cm. Of the six conversions, five were performed for adrenal tumours ≥6 cm [local invasion (n = 3), adhesions (n = 1), primary renal carcinoma (n = 1)]. All tumours in the LA group were resected with clear margins and at a median follow up of 50 months (range 38–74 months). There has been no evidence of local recurrence.

Conclusions

In the absence of local invasion, the outcomes of laparoscopic adrenalectomy for patients with tumours ≥6 cm were comparable to those with tumours <6 cm. This has helped confirm a policy of initial laparoscopic resection for all noninvasive adrenal tumours can be applied safely.

Keywords

Adrenalectomy Laparoscopic Large adrenal tumours 

References

  1. 1.
    Gagner M, Lacroix A, Bolte E (1992) Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 327:1003Google Scholar
  2. 2.
    Brunt LM, Doherty GM, Norton JA, Soper NJ, Quasebarth MA, Moley JF (1996) Laparoscopic adrenalectomy compared to open adrenalectomy for benign adrenal neoplasms. J Am Coll Surg 183:1–10PubMedGoogle Scholar
  3. 3.
    Dudley NE, Harrison BJ (1999) Comparison of open posterior versus transperitoneal laparoscopic adrenalectomy. Br J Surg 86:656–660PubMedCrossRefGoogle Scholar
  4. 4.
    Thompson GB, Grant CS, van Heerden JA, Schlinkert RT, Young WF Jr, Farley DR et al. (1997) Laparoscopic versus open posterior adrenalectomy: a case-control study of 100 patients. Surgery 122:1132–1136PubMedCrossRefGoogle Scholar
  5. 5.
    Imai T, Kikumori T, Ohiwa M, Mase T, Funahashi H (1999) A case-controlled study of laparoscopic compared with open lateral adrenalectomy. Am J Surg 178:50–54PubMedCrossRefGoogle Scholar
  6. 6.
    Brunt LM (2002) The positive impact of laparoscopic adrenalectomy on complications of adrenal surgery. Endosc Surg 16:252–257CrossRefGoogle Scholar
  7. 7.
    Henry JF, Sebag F, Iacobone M, Mirallie E (2002) Results of laparoscopic adrenalectomy for large and potentially malignant tumors. World J Surg 26:1043–1047PubMedCrossRefGoogle Scholar
  8. 8.
    Walz MK, Petersenn S, Koch JA, Mann K, Neumann HPH, Schmid KW (2005) Endoscopic treatment of large primary adrenal tumours. Br J Surg 92:719–723PubMedCrossRefGoogle Scholar
  9. 9.
    Shell SR, Talamini MA, Udelsman R (1998) Laparoscopic adrenalectomy for non-malignant disease: improved safety, morbidity and cost effectiveness. Surg Endosc 13:30–34CrossRefGoogle Scholar
  10. 10.
    Pisanu A, Jafari M, Pattou F, Carnaille B, Proye C (2001) Indications for adrenalectomy in the laparoscopic era. G Chir 22:101–106PubMedGoogle Scholar
  11. 11.
    Valeri A, Borrelli A, Presenti L et al. (2001) Adrenal masses in neoplastic patients: the role of laparoscopic procedure. Surg Endosc 15:90–93PubMedCrossRefGoogle Scholar
  12. 12.
    Gagner M, Pomp A, Heniford BT, Pharand D, Lacroix A (1997) Laparoscopic adrenalectomy: lessons learned from 100 consecutive procedures. Ann Surg 226:238–247PubMedCrossRefGoogle Scholar
  13. 13.
    Graham DJ, McHenry CR (1998) The adrenal incidentaloma: guidelines for evaluation and recommendations for management. Surg Oncol Clin North Am 7:749–764Google Scholar
  14. 14.
    Terzolo M, Ali A, Osella G, Mazza E (1997) Prevalence of adrenal carcinoma among incidentally discovered adrenal masses: a retrospective study from 1989 to 1994. Arch Surg 132:914–919PubMedGoogle Scholar
  15. 15.
    Sturgeon C, Shen WT, Clark OH, Duh QY, Kebebew E (2006) Risk assessment in 457 adrenal cortical carcinomas: How much does tumor size predict the likelihood of malignancy. J Am Coll Surg 202:423–430PubMedCrossRefGoogle Scholar
  16. 16.
    MacGillivray DC, Whalen GF, Malchoff CD, Oppenheim DS, Shichman SJ (2002) Laparoscopic resection of large adrenal tumours. Ann Surg Oncol 9:480–485PubMedCrossRefGoogle Scholar
  17. 17.
    Palazzo FF, Sebag F, Sierra M, Ippolito G, Souteyrand P, Henry JF (2006) Long-term outcome following laparoscopic adrenalectomy for large solid adrenal cortex tumors. World J Surg 30:893–898PubMedCrossRefGoogle Scholar
  18. 18.
    O’Boyle CJ, Kapadia CR, Sedman PC, Brough WA, Royston CMS (2003) Laparoscopic transperitoneal adrenalectomy: a prospective analysis of 172 procedures. Surg Endosc 17:1905–1909PubMedCrossRefGoogle Scholar
  19. 19.
    Weiss LM (1984) Comparative histopathologic study of 43 metastasizing and nonmetastasizing adrenocortical tumors. Am J Surg Pathol 8:163–9PubMedCrossRefGoogle Scholar
  20. 20.
    Aubert S, Wacrenier A, Leroy X, Devos P, Carnaille B, Proye C, Wemeau JL, Lecomte-Houcke M, Leteurtre E (2002) Weiss system revisited: a clinicopathologic and immunohistochemical study of 49 adrenocortical tumors. Am J Surg Pathol 26:1612–9PubMedCrossRefGoogle Scholar
  21. 21.
    Meyer A, Niemann U, Behrend M (2004) Experience with the surgical treatment of adrenal cortical carcinoma. Eur J Surg Oncol 30:444–449PubMedCrossRefGoogle Scholar
  22. 22.
    Kebebew E, Siperstein AE, Clark OH, Duh QY (2002) Results of laparoscopic adrenalectomy for suspected and unsuspected malignant adrenal neoplasms. Arch Surg 137:948–953PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • C. N. Parnaby
    • 1
    Email author
  • P. S. Chong
    • 1
  • L. Chisholm
    • 1
  • J. Farrow
    • 1
  • J. M. Connell
    • 2
  • P. J. O’ Dwyer
    • 1
  1. 1.University Department of SurgeryWestern InfirmaryGlasgowUnited Kingdom
  2. 2.University Department of EndocrinologyWestern InfirmaryGlasgowUnited Kingdom

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