Abstract
BackgroundLaparoscopic adrenalectomy is still controversial in cases where malignancy is suspected. However, many proponents of this technique argue that in the hands of an experienced surgeon, laparoscopy can be safely performed. The aim of this study is to present our own experience with the application of laparoscopic surgery for the treatment of malignant and potentially malignant adrenal tumours.MethodsOur analysis included 52 patients who underwent laparoscopic adrenalectomy in 2003–2014 due to a malignant or potentially malignant adrenal tumour. Inclusion criteria were primary adrenal malignancy, adrenal metastasis or pheochromocytoma with a PASS score greater than 6. We analyzed the conversion rate, intra- and postoperative complications, intraoperative blood loss and R0 resection rate. Survival was estimated using the Kaplan-Meier method.ResultsConversion was necessary in 5 (9.7 %) cases. Complications occurred in a total of 6 patients (11.5 %). R0 resection was achieved in 41 (78.8 %) patients and R1 resection in 9 (17.3 %) patients. In 2 (3.9 %) cases R2 resection was performed. The mean follow-up time was 32.9 months. Survival depended on the type of tumour and was comparable with survival after open adrenalectomy presented in other studies.ConclusionsWe consider that laparoscopic surgery for adrenal malignancy can be an equal alternative to open surgery and in the hand of an experienced surgeon it guarantees the possibility of noninferiority. Additionally, starting a procedure with laparoscopy allows for minimally invasive evaluation of peritoneal cavity. The key element in surgery for any malignancy is not the surgical access itself but the proper technique.
Highlights
Laparoscopic adrenalectomy is still controversial in cases where malignancy is suspected
Preoperative staging in all cases was comprised of computed tomography (CT), magnetic resonance imaging (MRI) or in selected cases a positron emission tomography (PET) scan
In the case of suspected pheochromocytoma, patients were preoperatively treated with alphablockers and intravenous volume expansion with crystalloids and colloids (2000 ml/day starting on the day before surgery)
Summary
Laparoscopic adrenalectomy is still controversial in cases where malignancy is suspected. The aim of this study is to present our own experience with the application of laparoscopic surgery for the treatment of malignant and potentially malignant adrenal tumours. Laparoscopic adrenalectomy is currently the gold standard for the surgical treatment of adrenal pathology [1, 2]. Indications for laparoscopy have gradually broadened since it has been established that practically any tumour, including very large ones, can be successfully removed with this technique. It has obviously typical advantages for minimally invasive surgery: a Pędziwiatr et al BMC Surgery (2015) 15:101 experience with the application of laparoscopic surgery in the treatment of malignant and potentially malignant adrenal tumours. All the patients were subject to regular follow-up, which included clinical examination and imaging tests
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