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Surgical Endoscopy

, Volume 27, Issue 3, pp 992–999 | Cite as

Modified anatomical retroperitoneoscopic adrenalectomy for adrenal metastatic tumor: technique and survival analysis

  • Xin Ma
  • Hongzhao Li
  • Xu ZhangEmail author
  • Qingbo Huang
  • Baojun Wang
  • Taoping Shi
  • Dongliang Hu
  • Qing Ai
  • Shangwen Liu
  • Jiangping Gao
  • Yong Yang
  • Jun Dong
  • Tao Zheng
Article

Abstract

Background

In a previous experience, anatomical retroperitoneoscopic adrenalectomy (ARA) was proven safe, effective, and technically efficient for surgical adrenal diseases. However, laparoscopic adrenalectomy for adrenal metastasis is controversial. We evaluated the safety, effectiveness, and efficiency of modified ARA technique for adrenal metastasis and predicted survival factors.

Methods

From 2000 to 2010, a consecutive series of 75 patients with adrenal metastases underwent 78 ARAs (three bilateral ARAs). Three modifications and one key procedure were specified in this study. Medical records and follow-up data were retrospectively studied. Then, the surgery data of ARA were compared with those of other approaches to evaluate its safety, effectiveness, and efficiency. Additionally, univariate and multivariate analyses were used to predict the risk factors for survival.

Results

The most common primary tumor was renal cell carcinoma (RCC, n = 26), followed by non-small-cell lung carcinoma (NSCLC, n = 23), and hepatocellular carcinoma (HCC, n = 12). A total of 76 successful ARAs and two conversions to open surgery were performed, with a median operation time of 53 (range, 40–250) min and median estimated blood loss of 25 (range, 10–700) mL. The local recurrence rate was 5.3 %, and the median survival was 24 months. These data were comparable with or even better than other approaches in previous studies. The independent prognostic factors of survival were body mass index (BMI, p < 0.001), tumor type (p < 0.001), tumor size (≥4 cm vs. <4 cm, p = 0.017), and margin status (negative vs. positive, p = 0.011).

Conclusions

ARA is a safe and effective approach for the management of adrenal metastasis in selected patients. BMI, tumor type, tumor size, and margin status may independently predict survival.

Keywords

Adrenal tumor Neoplasm metastasis Laparoscopy Adrenalectomy Follow-up Survival analysis 

Notes

Acknowledgments

This work was financially supported by the National Natural Science Foundation of China (No. 30972982) and Chinese Scientific Research Project for Health Industry (No. 201002010).

Disclosures

Xin Ma, Hongzhao Li, Xu Zhang, Qingbo Huang, Baojun Wang, Taoping Shi, Dongliang Hu, Qing Ai, Shangwen Liu, Jiangping Gao, Yong Yang, Jun Dong, and Tao Zheng have no conflicts of interest or financial ties to disclose. This work was financially supported by the National Natural Science Foundation of China (No. 30972982) and Chinese Scientific Research Project for Health Industry (No. 201002010).

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Xin Ma
    • 1
    • 2
  • Hongzhao Li
    • 1
    • 2
  • Xu Zhang
    • 1
    • 2
    Email author
  • Qingbo Huang
    • 1
    • 2
  • Baojun Wang
    • 1
    • 2
  • Taoping Shi
    • 1
    • 2
  • Dongliang Hu
    • 3
  • Qing Ai
    • 1
    • 2
  • Shangwen Liu
    • 1
    • 2
  • Jiangping Gao
    • 1
  • Yong Yang
    • 1
  • Jun Dong
    • 1
  • Tao Zheng
    • 1
    • 2
  1. 1.Department of UrologyChinese PLA General Hospital/Military Postgraduate Medical SchoolBeijingPeople’s Republic of China
  2. 2.State Key Laboratory of Kidney DiseasesChinese PLA General Hospital/Military Postgraduate Medical SchoolBeijingPeople’s Republic of China
  3. 3.Department of UrologyZhongnan Hospital of Wuhan UniversityWuhanPeople’s Republic of China

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