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Gibt es noch Indikationen für die offene Adrenalektomie?

Are there still indications for open adrenalectomy?

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Zusammenfassung

Trotz des Siegeszuges der minimal-invasiven Techniken in der Nebennierenchirurgie ist die Indikation zur offenen Adrenalektomie im Kanon der Therapiemöglichkeiten nicht wegzudenken und muss im Repertoire der Viszeralchirurgie vorhanden sein und bleiben. Die offene Adrenalektomie ist bei fortgeschrittenen Nebennierenkarzinomen (ENSAT-Stadium III) indiziert. Neben der häufigen lokalen Infiltration dieser Karzinome und der damit erforderlichen En-bloc-Resektion von Nachbarorganen können auch Thrombosen in der Nierenvene oder der Vena cava oder auch multiple Lymphknotenmetastasen ein offenes Vorgehen erforderlich machen. Aber auch bei einem Nebennierenkarzinom im ENSAT-Stadium I–II (Tumorgröße ≤ 5 und > 5 cm, N0) ist eine offene Adrenalektomie gerechtfertigt und muss diskutiert werden. Darüber hinaus können auch hochgradig suspekte große Nebennierentumoren (6–8 cm, Hounsfield-Einheiten > 20) ohne präoperativen Nachweis einer Malignität und andere Nebennierenpathologien wie Neuroblastome, große Phäochromozytome, aber auch Schwannome eine Indikation zur offenen Adrenalektomie sein.

Abstract

Despite the triumph of minimally invasive techniques in adrenal surgery, the indications for open adrenalectomy are indispensable in the canon of treatment options and must remain part of the repertoire of visceral surgery. Open adrenalectomy is indicated for advanced adrenal carcinoma (ENSAT stage III). In addition to the frequent local infiltration of these carcinomas which makes the en bloc resection of adjacent organs necessary, thromboses in the renal vein or the vena cava or multiple lymph node metastases can also necessitate an open procedure; however, open adrenalectomy is justified and must also be discussed for adrenocortical carcinoma ENSAT stages I–II (tumor size ≤ 5 cm or > 5 cm, NO). Furthermore, highly suspicious large adrenal tumors (6–8 cm, Hounsfield units > 20) without preoperative evidence of malignancy and other adrenal pathologies, such as neuroblastomas, large pheochromocytomas and also schwannomas can be an indication for open adrenalectomy.

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Literatur

  1. Autorino R, Bove P, De Sio M et al (2016) Open versus laparoscopic adrenalectomy for adrenocortical carcinoma: a meta-analysis of surgical and oncological outcomes. Ann Surg Oncol 23:1195–1202

    Article  Google Scholar 

  2. Arolfo S, Giraudo G, Franco C et al (2022) Minimally invasive adrenalectomy for large pheochromocytoma: not recommendable yet? Results from single institution case series. Langenbecks Arch Surg 407(1):277–283

    Article  Google Scholar 

  3. Cicek MC, Gunseren KO, Senol K et al (2021) Is 6 cm an upper limit for adrenal tumors to perform laparoscopic adrenalectomy? J Laparoendosc Adv Surg Tech A 31:301–305

    Article  Google Scholar 

  4. Delozier OM, Stiles ZE, Deschner BW et al (2021) Implications of conversion during attempted minimally invasive adrenalectomy for adrenocortical carcinoma. Ann Surg Oncol 28:492–501

    Article  Google Scholar 

  5. Deschner BW, Stiles ZE, Delozier OM et al (2020) Critical analysis of lymph node examination in patients undergoing curative-intent resection for adrenocortical carcinoma. J Surg Oncol 122:1152–1162

    Article  CAS  Google Scholar 

  6. Fassnacht M, Dekkers O, Else T et al (2018) European society of endocrinology clinical practice guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European network for the study of adrenal tumors. Eur J Endocrinol 179(4):G1–G46

    Article  CAS  Google Scholar 

  7. Fülber I, Peer K, Maurer E et al (2020) Two giant retroperitoneal schwannomas mimicking adrenal malignancy—a case report. Innov Surg Sci 5(1):75–79

    PubMed  PubMed Central  Google Scholar 

  8. Gaujoux S, Mihai R, joint working group of ESES and ENSAT (2017) European society of endocrine surgeons (ESES) and European network for the study of adrenal tumours (ENSAT) recommendations for the surgical management of adrenocortical carcinoma. Br J Surg 104(4):358–376. https://doi.org/10.1002/bjs.10414

    Article  CAS  PubMed  Google Scholar 

  9. Gerry JM, Tran TB, Postlewait LM et al (2016) Lymphadenectomy for adrenocortical carcinomas: is there a therapeutic benefit? Ann Surg Oncol 23(5):708–713

    Article  Google Scholar 

  10. Gumbs AA, Gagner M (2006) Laparoscopic adrenalectomy. Best Pract Res Clin Endocrinol Metab 20:483–499

    Article  Google Scholar 

  11. Hendricks A, Müller S, Fassnacht M et al (2022) Impact of lymphadenectomyon the oncologic outcome of patients with adrenocortical carcinoma—asystemic review and meta-analysis. Cancers 14(2):291

    Article  Google Scholar 

  12. Huynh KT, Lee DY, Lau BJ et al (2016) Impact of laparoscopic adrenalectomy on overall survival in patients with nonmetastatic adrenocortical carcinoma. J Am Coll Surg 223:485–492

    Article  Google Scholar 

  13. Kahramangil B, Kose E, Remer EM et al (2022) A modern assessment of cancer risk in adrenal incidentalomas—analysis of 2219 patients. Ann Surg 275(1):e238–e244. https://doi.org/10.1097/SLA.0000000000004048

    Article  PubMed  Google Scholar 

  14. Leboulleux S et al (2010) Adrenocortical carcinoma. Is the surgical approach a risk factor of peritoneal carcinomatosis? Eur J Endocrinol 162:1147–1153

    Article  CAS  Google Scholar 

  15. Li J, Wang Y, Chang X et al (2020) Laparoscopic adrenalectomy (LA) vs open adrenalectomy (OA) for pheochromocytoma (PHEO): asystematic review and meta-analysis. Eur J Surg Oncol 46:991–998

    Article  Google Scholar 

  16. Lorenz K, Langer P, Niederle H et al (2019) Surgical therapy of adrenal tumors: guidelines from the German association of endocrine surgeons (CAEK). Langenbecks Arch Surg 404(4):385–401

    Article  CAS  Google Scholar 

  17. Metman MJH, Viëtor CL, Seinen AJ et al (2022) Outcomes after surgical treatment of metastatic disease in the adrenal gland; valuable for the patient? Cancers 14:156. https://doi.org/10.3390/cancers14010156

    Article  Google Scholar 

  18. Miller BS (2020) “Old fashioned” open adrenalectomy. World J Surg 44:618–621

    Article  Google Scholar 

  19. Miller BS, Gauger PG, Hammer GD et al (2012) Resection of adrenocortical carcinoma is less complete and local recurrence occurs sooner and more often after laparoscopic adrenalectomy than after open adrenalectomy. Surgery 152:1150–1157

    Article  Google Scholar 

  20. Reibetanz J, Rinn B, Kunz AS et al (2019) Patterns of lymph node recurrence in adrenocortical carcinoma: possible implications for primary surgical treatment. Ann Surg Oncol 26(2):531–538

    Article  Google Scholar 

  21. Shah MH, Goldner WS, Benson AB et al (2021) Neuroendocrine and adrenal tumors, version 2.2021. J Natl Compr Canc Netw 19:839–868. https://doi.org/10.6004/jnccn.2021.0032

    Article  CAS  PubMed  Google Scholar 

  22. Taffurelli G, Ricci C, Casadei R et al (2017) Open adrenalectomy in the era of laparoscopic surgery: a review. Updates Surg 69:135–143

    Article  Google Scholar 

  23. Thompson LH, Makay Ö, Brunaud L et al (2021) Adrenalectomy for incidental and symptomatic phaeochromocytoma: retrospective multicentre study based on the Eurocrine ® database. Br J Surg 108:1199–1206

    Article  Google Scholar 

  24. Weber F, Belker J, Unger N et al (2020) Phäochromozytomatose nach Adrenalektomie: Metastasierung oder Zellverscleppung? Chirurg 91:345–353

    Article  CAS  Google Scholar 

  25. Wu K, Liu Z, Liang J et al (2018) Laparoscopic versus open adrenalectomy for localized (stage 1, 2) adrenocortical carcinoma: experience at a single, high-volume center. Surgery 164:1325–1329

    Article  Google Scholar 

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Authors and Affiliations

  1. Klinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Marburg, Baldingerstraße, 35043, Marburg, Deutschland

    K. Holzer & D. K. Bartsch

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  1. K. Holzer
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  2. D. K. Bartsch
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Correspondence to K. Holzer.

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K. Holzer und D. K. Bartsch geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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M. Anthuber, Augsburg

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Holzer, K., Bartsch, D.K. Gibt es noch Indikationen für die offene Adrenalektomie?. Chirurgie 93, 856–860 (2022). https://doi.org/10.1007/s00104-022-01678-9

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