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Partial versus Total Adrenalectomy by the Posterior Retroperitoneoscopic Approach: Early and Long-term Results of 325 Consecutive Procedures in Primary Adrenal Neoplasias

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Abstract

The retroperitoneoscopic approach is a standardized operative procedure for primary adrenal gland tumors. It allows direct access with a detailed view of the adrenal gland. Thereby, a clear differentiation between normal and neoplastic adrenal tissue is often possible, which permits a planned partial resection of the gland in selected cases. Between July 1994 and November 2003 325 posterior retroperitoneoscopic adrenalectomies were performed for primary benign adrenal gland tumors (106 Conn’s adenomas, 83 pheochromocytomas, 76 Cushing’s adenomas, 60 nonfunctioning tumors; size: 2.8 ± 1.5 cm; site: 160 right, 165 left) in 318 patients (122 M, 196 F, age: 49.0 ± 14.3 years). In 96 patients 100 tumors were removed by partial adrenalectomy (30 Conn’s adenomas, 33 pheochromocytomas, 20 Cushing’s adenomas, 17 nonfunctioning tumors; site: 61 right, 59 left) maintaining tumor-free parts of the adrenal gland. Of this group, 15 patients suffered from bilateral adrenal neoplastic diseases. During the same period, 225 total adrenalectomies (76 Conn’s adenomas, 50 pheochromocytomas, 56 Cushing’s adenomas, 34 nonfunctioning tumors; site: 109 right, 116 left) were performed in 224 patients. There was no mortality. Major complications were seen in 1.8%, minor complications in 14.5%. Three conversions were necessary to an open or a laparoscopic approach (2 patients and 1 patient, respectively). There are no differences between the two groups (total versus partial adrenalectomy) with regard to tumor size (2.8 ± 1.6 cm versus 2.8 ± 1.5 cm), operating time (80 ± 44 minutes versus 79 ± 42 minutes), and blood loss (33 ± 71 ml versus 29 ± 31 ml). In all patients with partial adrenalectomy, biochemical healing was proven. Fourteen of 15 patients with bilateral diseases had preservation of adrenocortical function. After a mean follow up of 51 months (range: 7–120 months) local recurrence or relapse of the initial diseases was noticed in 6 patients after total adrenalectomy: in 4 patients with Conn’s syndrome and bilateral hyperplasia, and in 2 patients with malignant pheochromocytoma and adrenocortical carcinoma, respectively. Our data demonstrate that partial adrenalectomy is a safe procedure not only perioperatively but also in the long-term follow-up.

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Authors and Affiliations

  1. Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Akademisches Lehrkrankenhaus der Universität Essen, Henricistrasse 92, D-45136, Essen, Germany

    Martin K. Walz M.D., Klaus Peitgen M.D. & Daniela Diesing

  2. Abteilung für Endokrinologie, Universitätsklinikum Essen, Hufelandstrasse 55, D-45122, Essen, Germany

    Stephan Petersenn M.D., Onno E. Janssen M.D. & Klaus Mann M.D.

  3. Abteilung für Nieren-und Hochdruckkrankheiten, Universitätsklinikum Essen, Hufelandstrasse 55, D-45122, Essen, Germany

    Thomas Philipp M.D.

  4. Institut für Pathologie, Universitätsklinikum Essen, Hufelandstrasse 55, D-45122, Essen, Germany

    Klaus A. Metz M.D. & Kurt W. Schmid M.D.

  5. Medizinische Klinik und Poliklinik, Abteilung für Innere Medizin IV, Universitätsklinikum Freiburg, Hugstetter Strasse 55, D-79106, Freiburg, Germany

    Hartmut P. H. Neumann M.D.

Authors
  1. Martin K. Walz M.D.
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  2. Klaus Peitgen M.D.
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  3. Daniela Diesing
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  4. Stephan Petersenn M.D.
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  5. Onno E. Janssen M.D.
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  7. Klaus A. Metz M.D.
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  8. Klaus Mann M.D.
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  10. Hartmut P. H. Neumann M.D.
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Correspondence to Martin K. Walz M.D..

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Walz, M., Peitgen, K., Diesing, D. et al. Partial versus Total Adrenalectomy by the Posterior Retroperitoneoscopic Approach: Early and Long-term Results of 325 Consecutive Procedures in Primary Adrenal Neoplasias. World J. Surg. 28, 1323–1329 (2004). https://doi.org/10.1007/s00268-004-7667-y

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