Laparoscopic transperitoneal lateral adrenalectomy for malignant and potentially malignant adrenal tumours

BMC Surgery

Andrzej Budzyński¹  Alicja Hubalewska-Dydejczyk³  Piotr Budzyński¹  Piotr Major¹  Magdalena Białas⁴  Maciej Matłok¹  Michał Natkaniec¹  Mateusz Wierdak²  Michał Pędziwiatr¹ 

[1] 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, Kraków, 31-501, Poland;Department of Physiology, Jagiellonian University, Grzegórzecka 16, Kraków, 31-531, Poland;Department of Endocrinology, Jagiellonian University, Kopernika 17, Kraków, 31-531, Poland;Department of Pathology, Jagiellonian University, Grzegórzecka 16, Kraków, 31-531, Poland

关键词: Laparoscopic adrenalectomy;    Adrenal metastasis;    Pheochromocytoma;    Adrenocortical cancer;   

Others  :  1223716
DOI  :  10.1186/s12893-015-0088-z

 received in 2015-01-07, accepted in 2015-08-21,  发布年份 2015

【 摘 要 】

Background

Laparoscopic adrenalectomy is still controversial in cases where malignancy is suspected. However, many proponents of this technique argue that in the hands of an experienced surgeon, laparoscopy can be safely performed. The aim of this study is to present our own experience with the application of laparoscopic surgery for the treatment of malignant and potentially malignant adrenal tumours.

Methods

Our analysis included 52 patients who underwent laparoscopic adrenalectomy in 2003–2014 due to a malignant or potentially malignant adrenal tumour. Inclusion criteria were primary adrenal malignancy, adrenal metastasis or pheochromocytoma with a PASS score greater than 6. We analyzed the conversion rate, intra- and postoperative complications, intraoperative blood loss and R0 resection rate. Survival was estimated using the Kaplan-Meier method.

Results

Conversion was necessary in 5 (9.7 %) cases. Complications occurred in a total of 6 patients (11.5 %). R0 resection was achieved in 41 (78.8 %) patients and R1 resection in 9 (17.3 %) patients. In 2 (3.9 %) cases R2 resection was performed. The mean follow-up time was 32.9 months. Survival depended on the type of tumour and was comparable with survival after open adrenalectomy presented in other studies.

Conclusions

We consider that laparoscopic surgery for adrenal malignancy can be an equal alternative to open surgery and in the hand of an experienced surgeon it guarantees the possibility of noninferiority. Additionally, starting a procedure with laparoscopy allows for minimally invasive evaluation of peritoneal cavity. The key element in surgery for any malignancy is not the surgical access itself but the proper technique.

【 授权许可】

   
2015 Pędziwiatr et al.

【 图 表 】

Fig. 1.

Fig. 2.

【 参考文献 】

• [1]Gumbs AA, Gagner M. Laparoscopic adrenalectomy. Best Pract Res Clin Endocrinol Metab. 2006; 20(3):483-499.
• [2]Smith CD, Weber CJ, Amerson JR. Laparoscopic adrenalectomy: new gold standard. World J Surg. 1999; 23(4):389-396.
• [3]Allolio B. Is endoscopic adrenalectomy the treatment of choice for large primary adrenal tumors? Nat Clin Pract Endocrinol Metab. 2006; 2(1):16-17.
• [4]Asari R, Koperek O, Niederle B. Endoscopic adrenalectomy in large adrenal tumors. Surgery. 2012; 152(1):41-49.
• [5]Henry JF, Sebag F, Iacobone M, Mirallie E. Results of laparoscopic adrenalectomy for large and potentially malignant tumors. World J Surg. 2002; 26(8):1043-1047.
• [6]Lombardi CP, Raffaelli M, De Crea C, Bellantone R. Role of laparoscopy in the management of adrenal malignancies. J Surg Oncol. 2006; 94(2):128-131.
• [7]Brix D, Allolio B, Fenske W, Agha A, Dralle H, Jurowich C et al.. Laparoscopic versus open adrenalectomy for adrenocortical carcinoma: surgical and oncologic outcome in 152 patients. Eur Urol. 2010; 58(4):609-615.
• [8]Strong VE, Kennedy T, Al-Ahmadie H, Tang L, Coleman J, Fong Y et al.. Prognostic indicators of malignancy in adrenal pheochromocytomas: clinical, histopathologic, and cell cycle/apoptosis gene expression analysis. Surgery. 2008; 143(6):759-768.
• [9]Motheral B, Brooks J, Clark MA, Crown WH, Davey P, Hutchins D et al.. A checklist for retrospective database studies--report of the ISPOR Task Force on Retrospective Databases. Value Health. 2003; 6(2):90-97.
• [10]Berruti A, Baudin E, Gelderblom H, Haak HR, Porpiglia F, Fassnacht M et al.. Adrenal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012; 23(7):vii131-8.
• [11]Stefanidis D, Goldfarb M, Kercher KW, Hope WW, Richardson W, Fanelli RD. SAGES guidelines for minimally invasive treatment of adrenal pathology. Surg Endosc. 2013; 27(11):3960-3980.
• [12]Pedziwiatr M, Natkaniec M, Kisialeuski M, Major P, Matlok M, Kolodziej D et al.. Adrenal incidentalomas: should we operate on small tumors in the era of laparoscopy? Int j endocrinol. 2014; 2014:658483.
• [13]Kulis T, Knezevic N, Pekez M, Kastelan D, Grkovic M, Kastelan Z. Laparoscopic adrenalectomy: lessons learned from 306 cases. J Laparoendosc Adv Surg Tech A. 2012; 22(1):22-26.
• [14]Musella M, Conzo G, Milone M, Corcione F, Belli G, De Palma M et al.. Preoperative workup in the assessment of adrenal incidentalomas: outcome from 282 consecutive laparoscopic adrenalectomies. BMC Surg. 2013; 13:57.
• [15]Conzo G, Tricarico A, Belli G, Candela S, Corcione F, Del Genio G et al.. Adrenal incidentalomas in the laparoscopic era and the role of correct surgical indications: observations from 255 consecutive adrenalectomies in an Italian series. Canadian journal of surgery Journal canadien de chirurgie. 2009; 52(6):E281-E285.
• [16]Mansmann G, Lau J, Balk E, Rothberg M, Miyachi Y, Bornstein SR. The clinically inapparent adrenal mass: update in diagnosis and management. Endocr Rev. 2004; 25(2):309-340.
• [17]Elder EE, Elder G, Larsson C. Pheochromocytoma and functional paraganglioma syndrome: no longer the 10 % tumor. J Surg Oncol. 2005; 89(3):193-201.
• [18]Bravo EL, Tagle R. Pheochromocytoma: state-of-the-art and future prospects. Endocr Rev. 2003; 24(4):539-553.
• [19]Chrisoulidou A, Kaltsas G, Ilias I, Grossman AB. The diagnosis and management of malignant phaeochromocytoma and paraganglioma. Endocr Relat Cancer. 2007; 14(3):569-585.
• [20]Thompson LD. Pheochromocytoma of the Adrenal gland Scaled Score (PASS) to separate benign from malignant neoplasms: a clinicopathologic and immunophenotypic study of 100 cases. Am J Surg Pathol. 2002; 26(5):551-566.
• [21]Agarwal A, Mehrotra PK, Jain M, Gupta SK, Mishra A, Chand G et al.. Size of the tumor and pheochromocytoma of the adrenal gland scaled score (PASS): can they predict malignancy? World J Surg. 2010; 34(12):3022-3028.
• [22]de Wailly P, Oragano L, Rade F, Beaulieu A, Arnault V, Levillain P et al.. Malignant pheochromocytoma: new malignancy criteria. Langenbecks Arch Surg. 2012; 397(2):239-246.
• [23]Conzo G, Musella M, Corcione F, De Palma M, Ferraro F, Palazzo A et al.. Laparoscopic adrenalectomy, a safe procedure for pheochromocytoma. A retrospective review of clinical series. Int J Surg. 2013; 11(2):152-156.
• [24]Liao CH, Chueh SC, Lai MK, Hsiao PJ, Chen J. Laparoscopic adrenalectomy for potentially malignant adrenal tumors greater than 5 centimeters. J Clin Endocrinol Metab. 2006; 91(8):3080-3083.
• [25]Hobart MG, Gill IS, Schweizer D, Sung GT, Bravo EL. Laparoscopic adrenalectomy for large-volume (> or = 5 cm) adrenal masses. J Endourol. 2000; 14(2):149-154.
• [26]Moreno P, de la Quintana BA, Musholt TJ, Paunovic I, Puccini M, Vidal O et al.. Adrenalectomy for solid tumor metastases: results of a multicenter European study. Surgery. 2013; 154(6):1215-1222.
• [27]Romero Arenas MA, Sui D, Grubbs EG, Lee JE, Perrier ND. Adrenal metastectomy is safe in selected patients. World J Surg. 2014; 38(6):1336-1342.
• [28]Sancho JJ, Triponez F, Montet X, Sitges-Serra A. Surgical management of adrenal metastases. Langenbecks Arch Surg. 2012; 397(2):179-194.
• [29]Vazquez BJ, Richards ML, Lohse CM, Thompson GB, Farley DR, Grant CS et al.. Adrenalectomy improves outcomes of selected patients with metastatic carcinoma. World J Surg. 2012; 36(6):1400-1405.
• [30]Adler JT, Mack E, Chen H. Equal oncologic results for laparoscopic and open resection of adrenal metastases. J Surg Res. 2007; 140(2):159-164.
• [31]Bradley CT, Strong VE. Surgical management of adrenal metastases. J Surg Oncol. 2014; 109(1):31-35.
• [32]Sarela AI, Murphy I, Coit DG, Conlon KC. Metastasis to the adrenal gland: the emerging role of laparoscopic surgery. Ann Surg Oncol. 2003; 10(10):1191-1196.
• [33]Sebag F, Calzolari F, Harding J, Sierra M, Palazzo FF, Henry JF. Isolated adrenal metastasis: the role of laparoscopic surgery. World J Surg. 2006; 30(5):888-892.
• [34]Strong VE, D'Angelica M, Tang L, Prete F, Gonen M, Coit D et al.. Laparoscopic adrenalectomy for isolated adrenal metastasis. Ann Surg Oncol. 2007; 14(12):3392-3400.
• [35]Valeri A, Bergamini C, Tozzi F, Martellucci J, Di Costanzo F, Antonuzzo L. A multi-center study on the surgical management of metastatic disease to adrenal glands. J Surg Oncol. 2011; 103(5):400-405.
• [36]Cooper AB, Habra MA, Grubbs EG, Bednarski BK, Ying AK, Perrier ND et al.. Does laparoscopic adrenalectomy jeopardize oncologic outcomes for patients with adrenocortical carcinoma? Surg Endosc. 2013; 27(11):4026-4032.
• [37]Gonzalez RJ, Shapiro S, Sarlis N, Vassilopoulou-Sellin R, Perrier ND, Evans DB et al.. Laparoscopic resection of adrenal cortical carcinoma: a cautionary note. Surgery. 2005; 138(6):1078-1085.
• [38]Leboulleux S, Deandreis D, Al Ghuzlan A, Auperin A, Goere D, Dromain C et al.. Adrenocortical carcinoma: is the surgical approach a risk factor of peritoneal carcinomatosis? Eur J Endocrinol. 2010; 162(6):1147-1153.
• [39]Miller BS, Ammori JB, Gauger PG, Broome JT, Hammer GD, Doherty GM. Laparoscopic resection is inappropriate in patients with known or suspected adrenocortical carcinoma. World J Surg. 2010; 34(6):1380-1385.
• [40]Nocca D, Aggarwal R, Mathieu A, Blanc PM, Deneve E, Salsano V et al.. Laparoscopic surgery and corticoadrenalomas. Surg Endosc. 2007; 21(8):1373-1376.
• [41]Porpiglia F, Fiori C, Daffara F, Zaggia B, Bollito E, Volante M et al.. Retrospective evaluation of the outcome of open versus laparoscopic adrenalectomy for stage I and II adrenocortical cancer. Eur Urol. 2010; 57(5):873-878.
• [42]Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg. 2010; 97(11):1638-1645.
• [43]Trastulli S, Cirocchi R, Listorti C, Cavaliere D, Avenia N, Gulla N et al.. Laparoscopic vs open resection for rectal cancer: a meta-analysis of randomized clinical trials. Colorectal Dis. 2012; 14(6):e277-e296.
• [44]Henry JF, Defechereux T, Raffaelli M, Lubrano D, Gramatica L. Complications of laparoscopic adrenalectomy: results of 169 consecutive procedures. World J Surg. 2000; 24(11):1342-1346.
• [45]Shen WT, Sturgeon C, Duh QY. From incidentaloma to adrenocortical carcinoma: the surgical management of adrenal tumors. J Surg Oncol. 2005; 89(3):186-192.
• [46]Janetschek G. Surgical options in adrenalectomy: laparoscopic versus open surgery. Curr Opin Urol. 1999; 9(3):213-218.
• [47]Lombardi CP, Raffaelli M, Boniardi M, De Toma G, Marzano LA, Miccoli P et al.. Adrenocortical carcinoma: effect of hospital volume on patient outcome. Langenbecks Arch Surg. 2012; 397(2):201-207.
• [48]Lachenmayer A, Cupisti K, Wolf A, Raffel A, Schott M, Willenberg HS et al.. Trends in adrenal surgery: institutional review of 528 consecutive adrenalectomies. Langenbecks Arch Surg. 2012; 397(7):1099-1107.