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Posterior Retroperitoneoscopic Adrenalectomy for Clinical and Subclinical Cushing’s Syndrome

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Abstract

Background

Because of co-morbidity, adrenalectomy for adrenal Cushing’s syndrome may be associated with an increased complication rate and long operating times. In the present study we report our experience with the posterior retroperitoneoscopic adrenalectomy in a large group of patients with clinical or subclinical Cushing’s syndrome.

Patients and methods

Between July 1994 and June 2009, 170 patients (17 males, 153 females age 50 ± 13 years; range: 12–78 years) affected by Cushing’s syndrome underwent operation via posterior retroperitoneoscopic access. Patients were divided into two groups, those with manifest Cushing’s syndrome (mCS) [99 patients: 6 male, 93 female; age 45 ± 13 years] and those with subclinical Cushing’s syndrome (sCS) [71 patients: 11 male, 60 female; age: 56 ± 11 years]. The sCS classification was assumed in cases without typical clinical symptoms but with a pathological dexamethasone suppression test. Partial adrenalectomy was performed in 35 cases (24 in the mCS-group and 11 in the sCS-group).

Results

Mortality was zero; major complications did not occur. The incidence of postoperative minor complications was 5.3%. Mean operating time was 58 ± 36 min (range: 20–230 min) and did not differ between mCS and sCS patients (58 versus 59 min; p = ns). Postoperative oral steroids supplementation (POSS) was administered in 136 patients (99 mCS, 37 sCS). If POSS was started, mean duration of therapy was 12.3 months (mCS) and 10.3 months (sCS) [p = 0.08], respectively. After a mean follow-up of 70.9 ± 46.5 months the cure rate was 99.4%.

Conclusions

The posterior retroperitoneoscopic approach is fast and safe even in patients with Cushing’s syndrome. Partial adrenalectomy represents a new option in the treatment of cortisol-producing adenomas.

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Authors and Affiliations

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

    Pier F. Alesina, Silvia Hommeltenberg, Beate Meier & Martin K. Walz

  2. Klinik für Endokrinologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany

    Stephan Petersenn, Harald Lahner & Klaus Mann

  3. Institut für Pathologie und Neuropathologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany

    Kurt W. Schmid

Authors
  1. Pier F. Alesina
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  2. Silvia Hommeltenberg
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  3. Beate Meier
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  4. Stephan Petersenn
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  7. Klaus Mann
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  8. Martin K. Walz
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Correspondence to Pier F. Alesina.

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Alesina, P.F., Hommeltenberg, S., Meier, B. et al. Posterior Retroperitoneoscopic Adrenalectomy for Clinical and Subclinical Cushing’s Syndrome. World J Surg 34, 1391–1397 (2010). https://doi.org/10.1007/s00268-010-0453-0

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  • DOI: https://doi.org/10.1007/s00268-010-0453-0

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