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

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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.

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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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Authors and Affiliations

  1. Department of Urology, Chinese PLA General Hospital/Military Postgraduate Medical School, Beijing, 100853, People’s Republic of China

    Xin Ma, Hongzhao Li, Xu Zhang, Qingbo Huang, Baojun Wang, Taoping Shi, Qing Ai, Shangwen Liu, Jiangping Gao, Yong Yang, Jun Dong & Tao Zheng

  2. State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Military Postgraduate Medical School, Beijing, 100853, People’s Republic of China

    Xin Ma, Hongzhao Li, Xu Zhang, Qingbo Huang, Baojun Wang, Taoping Shi, Qing Ai, Shangwen Liu & Tao Zheng

  3. Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430077, People’s Republic of China

    Dongliang Hu

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  1. Xin Ma
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  2. Hongzhao Li
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  3. Xu Zhang
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  8. Qing Ai
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  12. Jun Dong
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Corresponding author

Correspondence to Xu Zhang.

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Ma, X., Li, H., Zhang, X. et al. Modified anatomical retroperitoneoscopic adrenalectomy for adrenal metastatic tumor: technique and survival analysis. Surg Endosc 27, 992–999 (2013). https://doi.org/10.1007/s00464-012-2553-4

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  • DOI: https://doi.org/10.1007/s00464-012-2553-4

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