Endoscopic treatment of large primary adrenal tumours

Background: Endoscopic adrenalectomy has become the treatment of choice for small benign adrenal tumours but should not be used for malignant lesions. It is debatable whether large and therefore potentially malignant primary adrenal tumours should be removed by minimally invasive techniques. Methods...

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Bibliographic Details
Published in:British journal of surgery 2005-06, Vol.92 (6), p.719-723
Main Authors: Walz, M. K., Petersenn, S., Koch, J. A., Mann, K., Neumann, H. P. H., Schmid, K. W.
Format: Article
Language:English
Subjects:
Adolescent
Adrenal Gland Neoplasms - pathology
Adrenal Gland Neoplasms - surgery
Adrenalectomy - methods
Adrenocortical Carcinoma - pathology
Adrenocortical Carcinoma - surgery
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Blood Loss, Surgical
Child
Endoscopy - methods
Female
General aspects
Humans
Length of Stay
Male
Medical sciences
Middle Aged
Neoplasm Recurrence, Local - pathology
Pheochromocytoma - pathology
Pheochromocytoma - surgery
Prospective Studies
Statistics, Nonparametric
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Summary:Background: Endoscopic adrenalectomy has become the treatment of choice for small benign adrenal tumours but should not be used for malignant lesions. It is debatable whether large and therefore potentially malignant primary adrenal tumours should be removed by minimally invasive techniques. Methods: Three hundred and eighty primary adrenal tumours in 368 patients (142 male and 226 female; mean(s.d.) age 48·9(14·4) years) were excised by laparoscopic or retroperitoneoscopic adrenalectomy. Adrenal neoplasias exceeded 6 cm in diameter (range 6–13 cm) in 33 patients (18 male and 15 female; age 42·6(14·2) years). Results: There were no deaths. Patients with large tumours had an increased conversion rate (P = 0·039), longer operating time (P < 0·001) and greater intraoperative blood loss (P = 0·007) than those with smaller lesions, but a similar overall morbidity rate (P = 0·207). Six malignant tumours were identified (diameter 4–10 cm; four phaeochromocytomas and two adrenocortical carcinomas). Local recurrence developed in two patients and distant metastasis occurred in all six patients with malignant lesions. Conclusion: Endocopic adrenalectomy perfomed by an experienced surgeon should be the treatment of choice for tumours exceeding 6 cm in diameter. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Endoscopic operation is safe even for large tumours
ISSN:0007-1323
1365-2168
DOI:10.1002/bjs.4964