Preoperative workup in the assessment of adrenal incidentalomas: outcome from 282 consecutive laparoscopic adrenalectomies

BMC Surgery

Research Article

Rosario Pivonello¹  Bernadette Biondi¹  Annamaria Colao¹  Giulio Belli²  Annunziato Tricarico³  Marco Milone⁴  Mario Musella⁴  Paolo Bianco⁴  Maurizio De Palma⁵  Antonietta Palazzo⁶  Giovanni Conzo⁶  Luigi Santini⁶  Francesco Corcione⁷ 

[1] Endocrinology, “Federico II” University, Naples, Italy;General Surgery, “S. Maria di Loreto Nuovo” Hospital, Naples, Italy;General and Emergency Surgery, AORN “A. Cardarelli” Hospital, Naples, Italy;General and Emergency Surgery, “Federico II” University, Naples, Italy;General and Endocrine Surgery, AORN “A. Cardarelli” Hospital, Naples, Italy;General and Endocrine Surgery, Second University “SUN”, Naples, Italy;General and Laparoscopic Surgery, AORN “Monaldi” Hospital, Naples, Italy;

关键词: Laparoscopic adrenalectomy;    Incidentaloma;    Adrenocortical cancer;    Preoperative workup;    Pheochromocytoma;    Guidelines;   

DOI  :  10.1186/1471-2482-13-57

 received in 2013-05-21, accepted in 2013-11-21,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundTo confirm the efficacy of preoperative workup, the authors analyse the results of a multicentre study in a surgical series of patients diagnosed with an adrenal incidentaloma.MethodsThe retrospective review of a prospectively collected database was conducted. The data was obtained by six surgical units operating in the Campania Region, Italy. Five-hundred and six (506) adrenalectomies performed between 1993 and 2011 on 498 patients were analysed. Final histology in patients with a preoperative diagnosis of incidentaloma and studied according to guidelines (230/282 patients group A) was compared with final histology coming from patients presenting the same preoperative diagnosis but studied not according to guidelines (52/282 patients group B).ResultsIn group A preoperative diagnosis was confirmed at final histology in 76/81 (93.8%) cases of subclinical functioning lesions presenting as an incidentaloma. The preoperative detection of pheochromocytoma and primary adrenocortical cancer (ACC) reached 91.6% and 84.6% respectively. In group B conversion rate to open surgery was higher than in group A (p = 0.02). One pheochromocytoma was missed at preoperative diagnosis whereas one ACC smaller than 4 centimetres (cm) and coming from an incidental lesion was discovered. In both groups a significant association between increasing dimensions of incidentaloma and cancer has been observed (p = 0.001).ConclusionsThis surgical series confirm the high efficacy of suggested guidelines. A significant preoperative detection rate of adrenal lesions presenting as incidentaloma is observed. The unnecessary number of adrenalectomies performed in understudied patients, causing higher morbidity, was not associated to a higher detection rate of primary adrenocortical cancer.

【 授权许可】

CC BY   
© Musella et al.; licensee BioMed Central Ltd. 2013