PD3-04 LESS POSTERIOR RETROPERITONEOSCOPIC ADRENALECTOMY: STEP-BY-STEP TECHNIQUE DESCRIPTION AND COMPARISON WITH 3-PORTS LATERAL RETROPERITONEAL APPROACH

Abstract

INTRODUCTION AND OBJECTIVES: When a biochemically active adrenal mass is found surgery is usually recommended. While partial adrenalectomy is gaining popularity for small adrenal masses, it is not clear which patients will benefit from adrenal sparing to preserve adrenal function in case of contralateral adrenal pathology. We reviewed the available literature to evaluate the frequency of bilaterality of adrenal involvement with most common primary adrenal tumors and frequency of other pathologies potentially threatening the health of the adrenal gland. METHODS: We reviewed the PUBMED literature to evaluate the reported bilaterality of primary adrenal tumors including hereditary and nonhereditary pheochromocytomas (PHEOs), aldosterone producing adenomas (APAs), and cortisol producing adenomas and identified 25 articles describing the frequency of bilaterality of adrenalmasses.Wealso reviewed the literature to assess the etiologies of adrenal damage due to other pathological processes that may affect the adrenal gland in the lifespan of a patient and calculated the combined probability for adrenal damage. RESULTS: Table 1 reports the bilaterality of adrenal tumors in hereditary and non-hereditary diseases and demonstrates that adrenal tumors range in bilaterality between 4.25 e 80%. Hereditary PHEOs were bilateral in up to 80% of cases, while nonhereditary PHEOs were bilateral in up to 25%. APAs were bilateral in about 4% of cases, while only case reports reported bilaterality in cortisol producing tumors. Additionally, review of other processes such as infections, infiltrative etiologies, metastasis to adrenal, and others accounted for about 1% chance for the adrenal damage from all possible causes. CONCLUSIONS: Partial adrenalectomy is a valid option for patients with hereditary syndromes as there is an increased likelihood of disease in the contralateral gland. PHEOs followed by APAs appear to have the highest rate of bilateral involvement. Coupled with a possibility that an additional 1% of the population may have adrenals affected by various pathologic processes, partial adrenalectomy in patients with PHEO and APAs should be strongly considered. Percentage of bilaterality of adrenal tumors in hereditary syndromes and non-hereditary disease