Arch Hellen Med, 28(6), November-December 2011, 804-808
Open and laparoscopic surgery for malignant adrenal tumors
G.N. Zografos, I. Perysinakis, D. Vaidakis, D. Georgiadou, I. Spyridakis, A. Katseli, S. Avlonitis
OBJECTIVE Laparoscopic adrenalectomy has rapidly replaced open adrenalectomy as the procedure of choice for benign adrenal tumors. The aim of this study was to evaluate the short- and long-term results of laparoscopic and open surgery for malignant adrenal tumors, performed in one surgical unit.
METHOD A retrospective analysis of the records of patients with adrenal tumors was conducted. From May 1997 to December 2010, 240 adrenalectomies were performed on 229 patients. Eleven patients underwent either synchronous or metachronous bilateral adrenalectomy. The patients were 89 men and 140 women, aged from 16 to 80 years, of whom 13 had primary malignant cortical neoplasia, 4 malignant pheochromocytoma, 5 metastatic adrenal cancer from primary tumors of other origin, 3 paraganglioma and 4 potentially malignant tumors.
RESULTS Laparoscopic surgery was performed on 191 patients and open approach surgery on 22 patients. In 16 cases the laparoscopic procedure was converted to open surgery. With regard to the patients with malignancy, all the patients with metastatic tumors, 2 patients with primary cortical carcinoma and one with malignant pheochromocytoma were initially operated on laparoscopically, but conversion was made in 3 cases with cortical carcinoma and the one with malignant pheochromocytoma. Six patients with adrenocortical carcinoma needed block resection of other organs, by open approach. The 2 patients with potentially malignant adenocarcinoma and 2 with potentially malignant pheochromocytoma were all managed laparoscopically. The average postoperative hospital stay for patients treated by laparoscopic adrenalectomy ranged from 1 to 3 days (2.2 days), compared with 5 to 20 days for patients who underwent the open or converted procedure. With regard to the patients with malignancy, there was no perioperative mortality and morbidity included 2 wound infections following open procedures.
CONCLUSIONS Laparoscopic adrenalectomy is the treatment of choice for most metastatic adrenal tumors. Potentially malignant adrenal tumors must be resected laparoscopically. Malignant pheochromocytoma and large cortical malignant tumors are rarely amenable to laparoscopic surgery. Block resection of adjacent organs should be performed by planned open approach.
Key words: Adrenal tumors, Laparoscopic adrenalectomy, Malignant adrenal tumors.