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Wiederholungseingriffe an den Nebennieren

Recurrent operations on the adrenal glands

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Zusammenfassung

Wiederholungseingriffe an den Nebennieren können bei ipsilateralen benigen oder malignen Rezidiven nach subtotaler oder totaler Adrenalektomie, aber auch bei kontralateralen Rezidiverkrankungen nach unilateraler Adrenalektomie erforderlich werden. Die chirurgische Behandlung von Lokalrezidiven maligner Nebennierentumoren erreicht zumindest bei adrenokortikalen Karzinomen bei kompletter und unter Umständen auch multiviszeraler Resektion die gleichen Ergebnisse wie die operative Therapie bei Erstmanifestation (Fünfjahresüberlebensraten zwischen 40–60%). Palliative Operationen sollten nur individuell zur Kontrolle endokriner Symptome erwogen werden, da eine Verlängerung der Überlebenszeit im Vergleich zur konservativen Therapie nicht eindeutig belegt ist. Der Stellenwert der endoskopischen Techniken bei großen (>5 cm) und somit potenziell malignen Nebennierentumoren muss in weiteren Studien untersucht werden, bevor eine abschließende Einschätzung möglich ist. Nach subtotaler Adrenalektomie hängt das Rezidivrisiko von der Grunderkrankung, Größe und Lokalisation des adrenalen Restgewebes, Dauer der Nachbeobachtung sowie, im Falle familiärer Phäochromozytome, von der zugrunde liegenden Mutation (Genotyp) ab.

Abstract

Repeat adrenalectomy may be required due to ipsilateral recurrence of benign or malignant adrenal tumors after previous total or subtotal adrenalectomy. Even for multivisceral resection in patients with adrenocortical carcinoma, complete resection of local recurrent tumor offers results similar to those of primary resection (5-year survival 40–60%). In contrast, since no benefit on long-term survival has been shown so far by tumor debulking, palliative tumor resection should only be performed individually for control of severe endocrine symptoms. The effect of endoscopic adrenalectomy in patients with large tumors (>5 cm) or suspected malignancy has still not been well examined. Further studies are required. In any case, during open or endoscopic approach, tumor spillage must be avoided to prevent local tumor cell implantation. Following subtotal adrenalectomy, the risk of ipsilateral recurrence correlates with disease, follow-up, localization, size of the adrenal remnant, and, in case of familial pheochromocytoma, probably with genotype.

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  1. Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale

    M. Brauckhoff & H. Dralle

  2. Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06097, Halle/Saale

    M. Brauckhoff

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Brauckhoff, M., Dralle, H. Wiederholungseingriffe an den Nebennieren. Chirurg 76, 227–237 (2005). https://doi.org/10.1007/s00104-005-1010-5

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