Clinical investigation on minimal invasive surgery for Cushing syndrome caused by adrenocortical adenoma: experience of 121 cases in a single center

Abstract

Objective To explore the efficacy and safety of minimal invasive adrenal sparing surgery for the treatment of Cushing syndrome caused by adrenocortical adenoma. Methods Patients who underwent minimal invasive adrenal surgery for adrenocortical adenoma in our institution from January 2010 to December 2015 were retrospectively analyzed. Preoperative, intraoperative, and postoperative variables were reviewed from the database. The mean patient age at diagnosis was 39 years and male∶female ratio was 10∶111. Of the 121 adenomas, 50 were located in the right adrenal and 71 in the left. The mean tumor size was 2.6 cm.84 cases had hypertension (69.4%), 36 cases had diabetes mellitus (29.8%), and 45 cases had obesity (37.2%). Postoperative follow-up was performed by evaluating adrenal gland function and imaging. Results Mininal invasive partial adrenalectomy was performed in 121 cases and the success rate of operation was 99.2%(120/121). Sixty-two cases received operation through retroperitoneal approach, and 59 cases were through transperitoneal approach. The median operative time was 50 min with a median blood loss of 50 ml. The mean postoperative hospital stay were (5.0±3.2) days.The vascular injury occurred in 2 cases (1 case in each surgical approach), while the abdominal organ injury occurred in 2 cases with 1 case of spleen injury and 1 case of liver injury (both in transperitoneal approach). Postoperative complications were observed in 6 cases: 1 case of deep venous thrombosis, 1 case of wound hematoma, 4 cases of wound infection. Cortisol substitution was given in 2 to 12 months (mean 6.2 months) postoperatively. One year after operation, the remission rate of hypertension, diabetes and obesity was 58.3%(49/84), 30.6%(11/36) and 60.0%(30/45), respectively. Conclusions Minimal invasive adrenal surgery using retroperitoneal and transperitoneal laparoscopic technique can be performed with low morbidity and achieve an excellent outcome.The perioperative hormone therapy may also play an important role. Key words: Cushing syndrome; Partial adrenalectomy; Transperitoneal laparoscopic surgery; Retroperitoneal laparoscopic surgery