Summary
Background: The frequency of subtotal adrenalectomy has increased since the introduction of endoscopic approaches. In this study, we examined technical aspects of endoscopic subtotal adrenalectomy with respect to postoperative adrenocortical function.
Methods: Sixteen patients with endoscopic subtotal adrenalectomy were included in this study (10 inherited phaeochromocytomas, five adrenocortical tumours, and one bilateral adrenocortical hyperplasia). Unilateral tumours were found in 10 patients, and bilateral tumours were found in five patients. The five patients with bilateral tumours underwent unilateral subtotal adrenalectomy following contralateral total adrenalectomy. In these patients, the main adrenal vein was divided. Fifteen operations were performed laparoscopically. In one patient, the retroperitoneoscopic approach was used. In patients with bilateral operations, an ACTH test was performed postoperatively.
Results: More than one-third of one adrenal gland was left in situ in four patients. In eight patients, an adrenal remnant of about one-third of an adrenal gland was preserved. In the remaining four patients, the adrenal remnant was smaller than one-third. There were no complications. During a mean follow-up of 27 months, no recurrence was observed. Four of the five patients with bilateral tumours had an intact ACTH test. Neither patient with bilateral operations required steroids. In all five patients, the adrenal remnant was about one-third of an adrenal gland.
Conclusions: Endoscopic subtotal adrenalectomy has a similar success rate to the open approach. As regards recurrent adrenal tumours and influencing factors, no conclusions can be drawn due to the short follow-up. One-third of an adrenal gland on one side is enough for sufficient adrenocortical function even after division of the main vein. The impact of subtotal adrenalectomy in patients with unilateral tumours has to be exmained in future studies.
Zusammenfassung
Grundlagen: Nach Einführung des endoskopischen Zugangs zu den Nebennieren ist eine deutliche Zunahme subtotaler Nebennierenresektionen zu beobachten. In der vorliegenden Arbeit sollen technische Aspekte der subtotalen Adrenalektomie im Hinblick auf die postoperative adrenokortikale Funktion untersucht werden.
Methodik: In die Untersuchung wurden 16 Patienten mit subtotaler Adrenalektomie eingeschossen (10 Patienten mit familiären Phäochromozytomen, fünf Patienten mit adrenokortikalen Tumoren, ein Patient mit bilateraler nodulärer Nebennierenrindhyperplasie). Bei zehn Patienten lagen unilaterale, bei fünf Patienten bilaterale Tumoren vor. Die Patienten mit bilateralen Tumoren wurden nach totaler Nebennierenentfernung kontralateral subtotal adrenalektomiert. Die Nebennierenvene wurde bei allen Patienten mit bilateralen Operationen durchtrennt. Fünfzehn Operation erfolgten laparoskopisch, eine Operation retroperitoneoskopisch. Patienten mit bilateralen Operationen wurden postoperativ einem ACTH-Test unterzogen.
Ergebnisse: Bei vier Patienten verblieben mehr als ein Drittel, bei acht Patienten ein Drittel und bei vier Patienten weniger als ein Drittel einer normalen Nebenniere. In keinem Fall traten perioperativ Komplikationen auf. In einem mittleren Follow-up von 27 Monaten wurde kein Rezidiv beobachtet. Vier der fünf Patienten mit bilateralen Tumoren wiesen einen normalen ACTH-Test auf. Keiner dieser Patienten benötigte Glukokortikoide. Bei allen fünf Patienten verblieb unilateral ein Drittel einer normalen Nebenniere.
Schlußfolgerungen: Die endoskopische subtotale Adrenalektomie weist eine ähnliche Erfolgsquote wie beim konventionell offenen Zugang auf. Hinsichtlich der Rezidivrate kann aufgrund des kurzen Follow-up keine Aussage zu Rezidivhäufigkeit und diese beeinflussende Faktoren getroffen werden. Auch bei Durchtrennung der Hauptvene ist ein unilateraler adrenaler Geweberest von einem Drittel einer normalen Nebenniere für eine suffiziente adrenokortikale Funktion ausreichend. Weitere Untersuchungen mit längerem Follow-up sind erforderlich.
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An erratum to this article is available at http://dx.doi.org/10.1046/j.1682-4016.2003.30672.x.
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Brauckhoff, M., Kaczirek, K., Thanh, P.N. et al. Technical aspects of subtotal endoscopic adrenalectomy. Eur Surg 35, 84–88 (2003). https://doi.org/10.1046/j.1682-4016.2003.03052.x
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DOI: https://doi.org/10.1046/j.1682-4016.2003.03052.x