Long term follow-up of benign functional adrenocortical tumors in the era of robotic surgery

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Long-term outcome after operation for benign functional adrenal tumours [aldosteronoma (PA), subclinical (SCS) or clinical Cushing ́s syndrome (CS)] has not been reported extensively, especially not in the era of robotic-assisted laparoscopic surgery why pheochromocytomas has not been included in the group of benign functional masses? We have excluded pheocromocytoma because it is well known that it is very difficult to distinguish between malignant and benign pheocromocytomas. Since our aim was to evaluate benign lesions, we excluded pheocromocytomas. The purpose of this study was to investigate the clinical outcome for patients having undergone adrenalectomy for non-malignant clinical or subclinical functional adrenocortical tumors. The records of 65 patients with benign functional adrenocortical tumors treated with laparoscopic adrenalectomy (80% robotic assisted) were surveyed retrospectively. Clinical and biochemical data were evaluated at baseline and follow-up data was collected by a survey distributed to referring endocrinology centers. Cure was defined both in objective measurements and in the subjective validation of the endocrinologists referring the patients for surgery. According to our definition, 83% of patients with PA were either cured (normotension without anti-hypertensive medication), or improved (better blood pressure control with equal or fewer medications). For CS, 89% of patients were cured (biochemical normalization and lack of or significant improvement in co-morbidities). With the same definition, 73% of SCS patients were cured. The endocrinologists considered 86% of PA patients, 100% of CS and 64% of SCS patients as cured. Complications were few and there was no mortality. Robotic assisted adrenalectomy provides safe and effective treatment for PA, CS and SCS. Our objective definition of cure matched the assessment of cure of the endocrinologists in patients with PA and CS.