Evaluation of the Clinical Indications and Surgical Methods in Patients Who Underwent Adrenalectomy

Yıl 2021, Cilt: 54 Sayı: 1, 117 - 122, 27.04.2021

Abdullah Durhan , Marlen Süleyman

https://doi.org/10.20492/aeahtd.884074

Cited By: 1

Öz

Aim: The aim of this study was to evaluate the clinical surgical indications, surgical method selection criteria, and histopathological results of patients who were operated on with the diagnosis of adrenal mass in our general surgery clinic.
Material and method: A retrospective analysis was made of the data retrieved from the hospital database of patients who underwent surgery for adrenal mass in our general surgery clinic between January 2016 and January 2021. The data examined included demographic characteristics, American Anesthesiologists Association (ASA) score, preoperative clinical diagnosis, surgical technique, perioperative complications, duration of hospital stay, and histopathological results.
Results: A total of 16 patients underwent surgery for a diagnosis of adrenal mass in the specified study period. The patients comprised 13 (81.25%) females and 3 (18.75%) males with a mean age of 50.31 ± 15.06 years, and mean ASA score of 1.87 ± 0.61. Surgery was performed by open adrenalectomy (OA) in 3 (18.75%) cases and laparoscopic transperitoneal lateral adrenalectomy (LTLA) in 13 (81.25%) cases. The preoperative clinical diagnosis was functional tumour in 10 (62.5%) patients and non-functional mass in 6 (37.5%).
Conclusion: Although adrenal gland tumors are extremely rare, a multidisciplinary approach is very important at the stages of diagnosis, surgical method selection, and postoperative follow-up. Surgeons should select the surgical method in which they are most experienced and trained, to be able to obtain the best results considering the risk factors.

Anahtar Kelimeler

Adrenal tumor, laparoscopic adrenalectomy, open adrenalectomy

Adrenalektomi Yapılan Hastalarda Klinik Endikasyon ve Cerrahi Yöntemlerin Değerlendirilmesi

Öz

ÖZET
Amaç: Bu çalışmada genel cerrahi kliniğimizde, adrenal kitle tanısı ile opere edilen hastaların klinik cerrahi endikasyonlarını, cerrahi yöntem seçim kriterlerini ve histopatolojik sonuçlarını değerlendirmeyi amaçladık.
Gereç ve yöntem: Ocak 2016 -Ocak 2021 tarihleri arasında, genel cerrahi kliniğimizde adrenal kitle nedeni ile opere edilen tüm olguların demografik özellikleri, American Anesthesiologists Association (ASA) skoru, preoperatif klinik tanı, cerrahi yöntem, perioperatif komplikasyonlar, hastanede kalış süresi ve histopatolojik sonuçları retrospektif olarak değerlendirildi.
Bulgular: Adrenal kitle tanısı ile opere edilen toplam hasta sayısı 16 idi. Olguların 13 (%81.25)’ ü kadın, 3 (%18.75)’ ü ise erkekti. Yaş ortalaması 50,31±15,06, ASA skoru ortalaması:1.87±0.61 idi. Olguların operasyon şekli 3 (%18.75)’ ü açık adrenalektomi (AA), 13 (%81.25)’ ü ise laparoskopik transperitoneal lateral adrenalektomi (LTLA) ile yapıldı. Preoperatif klinik tanı olarak 10 (%62.5) hastanın fonksiyonel tümörü, 6 (%37.5) hastanın ise nonfonksiyonel kitlesi vardı.
Sonuç: Oldukça nadir görülen adrenal gland tümörlerinde gerek tanı aşamasında, gerek cerrahi yöntem seçiminde ve gerekse postoperatif takip sürecinde multidisipliner yaklaşımın çok önemli olduğu kanaatindeyiz. Cerrahlar risk faktörlerini de göz önüne alarak, eğitim aldıkları, en deneyimli oldukları ve en iyi sonucu alabileceği cerrahi yöntemi seçmelidir.

Anahtar Kelimeler

Adrenal tümör, laparoskopik adrenalektomi, açık adrenalektomi

Kaynakça

• 1. Bourdeau I, El Ghorayeb N, Gagnon N, et al. MANAGEMENT OF ENDOCRINE DISEASE: Differential diagnosis, investigation and therapy of bilateral adrenal incidentalomas. European journal of endocrinology. 2018;179: 57-67.
• 2. Zeiger M, Thompson G, Duh Q-Y, et al. American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Incidentalomas. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2009;15: 1-20.
• 3. Boland GW, Blake MA, Hahn PF, et al. Incidental adrenal lesions: principles, techniques, and algorithms for imaging characterization. Radiology. 2008;249: 756-75.
• 4. Zeiger MA, Thompson GB, Duh QY, et al. American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Incidentalomas: executive summary of recommendations. Endocr Pract. 2009;15: 450-3.
• 5. Alemanno G, Bergamini C, Prosperi P, et al. Adrenalectomy: indications and options for treatment. Updates in surgery. 2017;69: 119-25.
• 6. Abrams HL, Spiro R, Goldstein N. Metastases in carcinoma; analysis of 1000 autopsied cases. Cancer. 1950;3: 74-85.
• 7. Wu C-T, Chiang Y-J, Chou C-C, et al. Comparative study of laparoscopic and open adrenalectomy. Chang Gung Med J. 2006;29: 468-73.
• 8. Gagner M, Lacroix A, Bolté E. Laparoscopic adrenalectomy in Cushing's syndrome and pheochromocytoma. N Engl J Med. 1992;327: 1033.
• 9. Fernández-Cruz L, Saenz A, Benarroch G, et al. Laparoscopic unilateral and bilateral adrenalectomy for Cushing's syndrome. Transperitoneal and retroperitoneal approaches. Ann Surg. 1996;224: 727-36.
• 10. Pahwa M. Robot-assisted adrenalectomy: current perspectives. Robotic surgery (Auckland). 2017;4: 1-6. 11. Lenders JW, Eisenhofer G, Mannelli M, et al. Phaeochromocytoma. Lancet. 2005;366: 665-75.
• 12. Chiodini I. Clinical review: Diagnosis and treatment of subclinical hypercortisolism. J Clin Endocrinol Metab. 2011;96: 1223-36.
• 13. Médeau V, Moreau F, Trinquart L, et al. Clinical and biochemical characteristics of normotensive patients with primary aldosteronism: a comparison with hypertensive cases. Clin Endocrinol (Oxf). 2008;69: 20-8.
• 14. Shen WT, Grogan R, Vriens M, et al. One hundred two patients with pheochromocytoma treated at a single institution since the introduction of laparoscopic adrenalectomy. Arch Surg. 2010;145: 893-7.
• 15. Bornstein SR, Gimenez-Roqueplo AP. Genetic testing in pheochromocytoma: increasing importance for clinical decision making. Annals of the New York Academy of Sciences. 2006;1073: 94-103.
• 16. Costa MH, Ortiga-Carvalho TM, Violante AD, et al. Pheochromocytomas and Paragangliomas: Clinical and Genetic Approaches. Front Endocrinol (Lausanne). 2015;6: 126.
• 17. Nagaraja V, Eslick GD, Edirimanne S. Recurrence and functional outcomes of partial adrenalectomy: a systematic review and meta-analysis. Int J Surg. 2015;16: 7-13.
• 18. O'Neill CJ, Spence A, Logan B, et al. Adrenal incidentalomas: risk of adrenocortical carcinoma and clinical outcomes. J Surg Oncol. 2010;102: 450-3.
• 19. Parnaby CN, Chong PS, Chisholm L, et al. The role of laparoscopic adrenalectomy for adrenal tumours of 6 cm or greater. Surg Endosc. 2008;22: 617-21.
• 20. Else T, Williams AR, Sabolch A, et al. Adjuvant therapies and patient and tumor characteristics associated with survival of adult patients with adrenocortical carcinoma. J Clin Endocrinol Metab. 2014;99: 455-61.
• 21. Cooper AB, Habra MA, Grubbs EG, et al. Does laparoscopic adrenalectomy jeopardize oncologic outcomes for patients with adrenocortical carcinoma? Surg Endosc. 2013;27: 4026-32.
• 22. Miller BS, Gauger PG, Hammer GD, et al. Resection of adrenocortical carcinoma is less complete and local recurrence occurs sooner and more often after laparoscopic adrenalectomy than after open adrenalectomy. Surgery. 2012;152: 1150-7.
• 23. Fosså A, Røsok BI, Kazaryan AM, et al. Laparoscopic versus open surgery in stage I-III adrenocortical carcinoma -- a retrospective comparison of 32 patients. Acta oncologica (Stockholm, Sweden). 2013;52: 1771-7.
• 24. Lombardi CP, Raffaelli M, De Crea C, et al. Open versus endoscopic adrenalectomy in the treatment of localized (stage I/II) adrenocortical carcinoma: results of a multiinstitutional Italian survey. Surgery. 2012;152: 1158-64.
• 25. Donatini G, Caiazzo R, Do Cao C, et al. Long-term survival after adrenalectomy for stage I/II adrenocortical carcinoma (ACC): a retrospective comparative cohort study of laparoscopic versus open approach. Ann Surg Oncol. 2014;21: 284-91.
• 26. Smith CD, Weber CJ, Amerson JR. Laparoscopic adrenalectomy: new gold standard. World J Surg. 1999;23: 389-96.
• 27. Conzo G, Musella M, Corcione F, et al. Laparoscopic adrenalectomy, a safe procedure for pheochromocytoma. A retrospective review of clinical series. Int J Surg. 2013;11: 152-6.
• 28. Toniato A, Boschin IM, Opocher G, et al. Is the laparoscopic adrenalectomy for pheochromocytoma the best treatment? Surgery. 2007;141: 723-7.
• 29. Kercher KW, Novitsky YW, Park A, et al. Laparoscopic curative resection of pheochromocytomas. Ann Surg. 2005;241: 919-28.
• 30. Remine WH, Chong GC, Van Heerden JA, et al. Current management of pheochromocytoma. Ann Surg. 1974;179: 740-8.
• 31. Stefanidis D, Goldfarb M, Kercher KW, et al. SAGES guidelines for minimally invasive treatment of adrenal pathology. Surg Endosc. 2013;27: 3960-80.