Radical Adrenalectomy Research Articles

Safety and curative effect analysis of bilateral simultaneous adrenalectomy for the treatment of the bilateral adrenal pheochromocytoma associated with multiple endocrine neoplasia type 2A

Objective To study the clinical features of the bilateral adrenal pheochromocytomas (PHEO) in patients associated with multiple endocrine neoplasia type 2A (MEN2A) and to evaluate the safety and feasibility of applying simultaneous bilateral adrenalectomy (SBA).Methods From November 2003 to April 2011,clinical data of 8 patients from 4 unrelated MEN2A families treated with SBA were analyzed.There were 6 males and 2 females.The mean age was 44 years (range,35 to 56 years).4 patients were asymptomatic and 4 had clinical features related to PHEO.The diagnosis of bilateral PHEO was made after the diagnosis of MTC in 4 cases,previous hypertension in 1 case,and family investigation found 3 MTC and all were found with hyperparathyroidism.Plasma catecholamines were substantially elevated in 4 patients.Ultrasound and computerized tomography (CT) examination showed bilateral adrenal masses,of which 6 were bilateral and multiple tumors,2 were single tumor in one side and multiple tumors in the other side.On contrast CT,the tumors displayed heterogeneous contrast enhancement and low density area in the center of the tumors observed in 3 cases;renal,splenic vessels displacement and deformation were observed;local lymph node enlargement was not found.The mean maximum diameter of PHEO was 4.4 cm (range,2.7 to 7.0 cm).RET screening showed a heterozygous nucleotide substitution on exon 11,c.G1901A (p.C634Y) in all patients.After adequate adrenergic blockade,the SBA was performed by a single surgeon,PHEO were extirpated by laparoscopic radical adrenalectomy in 2 patie.nts,while in other 6 patients,PHEO were removed by partial adrenalectomy or adrenal tumorectomy with at least one normal appearing adrenal tissue preserved (4 by laparoscopic approach and 2 by open approach).Results The procedures were successful carried out on 8 cases with bilateral PHEO.There were totally 43 pieces of tumor obtained.The average time of operation was 181 min (range,150 to 240 min).Mean blood loss was 171ml (range,100 to 300 ml).Blood pressure fluctuations happened in 2 cases during operation (maximum:230/110 vs minimum:70/40 mm Hg).Histopathology showed PHEO in all patients.During the follow-up of 35 months (range,3 to 90),local and/or distant metastatic recurrence was not found in all cases,while two treated by total bilateral adrenalectomy and one by adrenal-sparing surgery required corticosteroid replacement.Conclusions SBA for bilateral PHEO in MEN2A is technically safe and feasible.Transperitoneal laparoscopic partial adrenalectomy for the treatment of bilateral PHEO can be considered as preferential choice. Key words: Multiple endocrine neoplasia type 2A; Pheochromocytoma; Bilateral simultaneous adrenalectomy; RET gene; Laparoscopy

Growing occult synchronous adrenal metastasis from rectal cancer after surgery and during adjuvant chemotherapy: A Case Report

Abstract We report a case of an occult synchronous adrenal metastasis of rectal cancer. A left adrenal mass was found by computed tomography (CT) 6 months after low anterior resection for rectal cancer. This lesion was growing during adjuvant systemic chemotherapy. The level of serum carcinoembryonic antigen and that of adrenal hormones were within the normal range. Radical left adrenalectomy was performed, and histopathological examination revealed metastatic adenocarcinoma compatible with rectal cancer. Adrenal metastasis is not rare in autopsy series. The possibility of adrenal metastasis should be considered in the follow-up of rectal cancer patients. Surgery may be the treatment of choice in occult synchronous metastasis of adrenal gland in rectal cancer.

25 DOES NEPHRECTOMY DURING RADICAL ADRENALECTOMY FOR ADRENOCORTICAL CANCER AFFECT ONCOLOGICAL RESULTS?

You have accessJournal of UrologyAdrenal: Surgery/Tumors/Benign and Malignant Disease1 Apr 201025 DOES NEPHRECTOMY DURING RADICAL ADRENALECTOMY FOR ADRENOCORTICAL CANCER AFFECT ONCOLOGICAL RESULTS? Francesco Porpiglia, Cristian Fiori, Fulvia Daffara, Barbara Zaggia, Roberto Mario Scarpa, and Massimo Terzolo Francesco PorpigliaFrancesco Porpiglia More articles by this author , Cristian FioriCristian Fiori More articles by this author , Fulvia DaffaraFulvia Daffara More articles by this author , Barbara ZaggiaBarbara Zaggia More articles by this author , Roberto Mario ScarpaRoberto Mario Scarpa More articles by this author , and Massimo TerzoloMassimo Terzolo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.069AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Adrenocortical cancer (ACC) is a rare but extremely aggressive tumor and surgery represents the only potential curative approach. During radical adrenalectomy nephrectomy is often performed with the aim to improve oncologic radicality. The aim of this study is to evaluate if concomitant nephrectomy affects oncological results of radical adrenalectomy for ACC. METHODS We retrospectively reviewed our prospectively maintained ACC database of our Centre and we extracted data about patients treated for stage I and II ACC with radical adrenalectomy (group A) and radical adrenalectomy with concomitant nephrectomy (group B). Exclusion criteria were: incomplete surgical resection, extensive surgery such as splenectomy, resection of pancreas tail or hepatectomy, age < 18 years, significant concomitant diseases. We considered age, sex, lesion size and weight, Weiss score, Ki 67 mitotic index, surgical margins status. Oncologic effectiveness of the procedures was tested comparing the recurrence-free survival of patients treated with adrenalectomy (group A) and adrenalectomy + nephrectomy (group B). Secondary outcome measures were differences in terms of overall survival. All statistical analyses were performed with Statistical software (StatSoft®) using Mann–Whitney U test and chi-square test. Survival curves were computed according to the Kaplan–Meier method and were compared by means of the log-rank test. All reported p values are two-sided. P values of less than 0.05 were considered to indicate statistical significance. RESULTS Group A consisted of 62 patients, group B of 20 patients. Mean age was 43 and 47 years respectively (p=ns). No differences were recorded in terms of sex, Weiss scores, Ki 67 index and weight of lesion, on the contrary lesion size was greater in group B (11.5 vs 14.3 cm, respectively, p=0.035). After a median follow up of 60 months, 28/62 (45%) patients of group A and 9/20 (45%) of group B deceased. Log rank test did not reveal significant differences between the two groups in terms of disease free survival and median overall survival. CONCLUSIONS Our data does not support the hypothesis that concomitant nephrectomy improves the oncologic radicality of adrenalectomy for ACC. In our opinion the surgeon should preserve the kidney during this intervention. Orbassano (Torino), Italy© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e11 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francesco Porpiglia More articles by this author Cristian Fiori More articles by this author Fulvia Daffara More articles by this author Barbara Zaggia More articles by this author Roberto Mario Scarpa More articles by this author Massimo Terzolo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A case of successful laparoscopic resection of adrenal gland endometriosis

To present a case of successful laparoscopic resection of adrenal endometriosis. Case report. University Hospital. Forty-eight-year-old woman with left-sided abdominal and flank pain. Laparoscopic radical adrenalectomy. Diagnosis and surgical approach to adrenal endometriosis. There have been two case reports of adrenal endometriosis. Based on a search of Medline and Google for "adrenal endometriosis," this is the first known successful laparoscopic resection of adrenal endometriosis. We report the first case of successful laparoscopic adrenalectomy for the treatment of endometriosis.

Noninvasive adrenal imaging in hyperaldosteronism

Proper management of primary aldosteronism requires localization of excess aldosterone production. Partial or radical adrenalectomy may cure cases of aldosterone-producing adenomas; however, pharmacologic management is indicated in cases of bilateral adrenal hyperplasia. Differentiating among the causes of primary aldosteronism can be a diagnostic challenge. Adrenal vein sampling, the gold standard for diagnosing subtypes of primary aldosteronism, is an invasive and often difficult procedure. Advancements in CT and MRI have improved their adrenal-imaging capabilities, but accuracy in identifying aldosterone-producing adenomas remains inferior to adrenal vein sampling. Radionuclide scintigraphy has been used for many years and can also provide functional information for diagnosis. No diagnostic test, however, distinguishes with complete accuracy aldosterone-producing adenomas from bilateral adrenal hyperplasia in primary aldosteronism. Therefore, a combination of diagnostic techniques may most effectively guide medical management.

Adrenocortical carcinoma with endocrine syndromes.

Adrenocortical carcinoma is a rare disease. A 32 years old lady presented with complaints of hypertension, abdominal swelling, weight gain, hirsutism and bone pains. She was found to have a large adrenocortical carcinoma with associated Cushing's and virilization syndromes. Radical adrenalectomy was done with subsequent plan for Mitotane and radio frequency ablation for hepatic metastasis. However, she succumbed to respiratory failure due to ARDS, a month after operation.

ES08 DIAGNOSTIC AND THERAPEUTIC STRATEGIES OF ADRENOCORTICAL CARCINOMA‐A 3‐INSTITUTION EXPERIENCE

Objective This paper reviews the diagnostic, therapeutic strategies and outcomes of ADCC in 3 Institutions between Newcastle and Sheffield in United Kingdom and Putrajaya, Malaysia.Patients and Methods A 10‐year retrospective analysis of proven cases of ADCC was collected from January 1997 to December 2006. The patients’ demographic data, clinical manifestation, site and size of the tumour were analysed. The record of metastasis, and therapeutic modality and outcomes were evaluated.Results A total of 22 cases of ADCC were documented in United Kingdom with 11 cases in each respective center. 16 cases were reviewed from Putrajaya. There was no gender preponderance and age significance. Cushing’s Syndrome was the most common clinical manifestation (36.4%) in United Kingdom and (37.5%) in Putrajaya. The mean size of the ADCC was 9.3 cm (5–15 cm) in Newcastle and 9.8 cm (6–15 cm) in Sheffield as compared to 15.7 cm (5–25 cm) in Putrajaya. There were 12(75%) of patients in Putrajaya were diagnosed with Stage IV disease upon presentation whilst only 3(27.3%) and 5(45.4%) patients had metastasis noted in Newcastle and Sheffield respectively. Of note, 7(63.3%) patients in Sheffield were offered radical adrenalectomy. Our data revealed that the 2 years survival of patients who had radical approach in Sheffield has the highest rate of survival of 8(72.7%) as compared to 5(45.4%) in Newcastle and 2(12.5%) in Putrajaya.Conclusions Surgical removal remains the only form of curative therapy and hope of prolonged survival. The poorer prognosis of patients in Putrajaya may be attributed to the advanced stage of the disease.

I-123 MIBG Scan of Metastatic Neuroblastoma Mimicking a Bone Scan

A 21-year-old man presented to an outside institution with longstanding right hip pain. Magnetic resonance imaging revealed diffuse marrow infiltration in the lumbar spine, sacrum, ilium, and right proximal femur. Biopsy of a left upper quadrant mass was consistent with stroma poor neuroblastoma with differentiation. The patient underwent left radical adrenalectomy, left retroperitoneal lymph node dissection with gross resection of residual tumor and 5 cycles of high-dose chemotherapy (cyclophosphamide, doxorubicin, and vincristine) with evidence of disease progression. A short course of irinotecan was given for palliation. A protocol with low-dose 1-131 MIBG was started for symptomatic control.

An Adrenocortical Carcinoma Patient with Multiple Lung Metastases-A Case Report

Adrenocortical carcinoma is a rare cause of Cushing's syndrome. Its aggressive behavior leads to a poor prognosis. Mitotane (o,p'-DDD) is the mainstay of medical therapy, but the adverse effects often limit its use. We report on a patient with adrenocortical carcinoma who was treated with mitotane. A 42-year-old woman presented with Cushing's syndrome and hirsutism. There were lung metastases at diagnosis. Right radical adrenalectomy and multiple lung metastatectomy were performed. Six months later, mitotane was administered for widely-disseminated metastases. It was discontinued because of severe side effects including dizziness, headache, generalized weakness, nausea, and vomiting. The patient died of hepatic failure one year after diagnosis. In these patients, mitotane may be used immediately after surgical resection as an adjuvant therapy if residual tumors were considered. A low-dose mitotane regimen should be given with monitoring of the serum level of the drug to obtain an optimal effect. Systemic chemotherapy may be administered or combined with mitotane if the tumor is poorly responsive to mitotane or the patient can not tolerate the drug. More experience is needed to determine the effect of various treatments.

LAPAROSCOPIC RADICAL ADRENALECTOMY FOR MALIGNANCY IN 31 PATIENTS

Laparoscopic adrenalectomy for malignancy is controversial. We analyzed our experience with laparoscopic radical adrenalectomy for cancer with an emphasis on predictors of surgical outcome and oncological followup data. Since July 1997, 31 patients have undergone a total of 33 laparoscopic adrenalectomies for malignancy. Mean adrenal tumor size was 5 cm (range 1.8 to 9). The laparoscopic approach was transperitoneal in 17 cases, retroperitoneal in 15 and transthoracic in 1. Data were obtained from patient charts, radiographic reports and direct telephone calls to patient families. Associated organ resection (radical nephrectomy) was performed in 3 patients. One case was electively converted to open surgery. There was no operative mortality. The pathological diagnoses were metastatic cancer in 26 cases and primary adrenal malignancy in 7. Current median followup, available on 30 patients, was 26 months (range 1 to 69). Overall 15 patients (48%) died and 16 (52%) were alive, of whom 13 (42%) showed no evidence of disease. Cancer specific survival at a median followup of 42 months was 53% and 5-year actuarial survival was 40%. Local recurrence was noted in 7 patients (23%). There were no port site metastases. Survival was similar in patients with tumors less than 5 cm vs 5 cm or greater. Survival was not associated with patient age, tumor size, operative time or surgical approach. Survival was compromised in patients with local recurrence (p = 0.016). Laparoscopic radical adrenalectomy can be performed with acceptable outcomes in the carefully selected patient with a small, organ confined, solitary adrenal metastasis or primary adrenal carcinoma. To our knowledge the largest series in the literature to date is presented.

Laparoscopic Radical Adrenalectomy With Adrenal Vein Tumor Thrombectomy: Technical Considerations

We describe the technique of adrenal vein tumor thrombectomy during laparoscopic radical adrenalectomy for cancer. During laparoscopic adrenalectomy for a heterogeneous 7 cm left adrenal mass an adrenal vein thrombus was detected intraoperatively. Laparoscopic ultrasonography was used to delineate precisely the tumor thrombus and its extension into the left main renal vein. The left renal artery and vein were transiently controlled with atraumatic vascular clamps. The renal vein was incised and the intact tumor thrombus was removed en bloc with the radical adrenalectomy specimen. The renal vein was suture repaired with 4-zero prolene and the kidney was revascularized. Renal warm ischemia time was 21 minutes, blood loss was 300 cc and operative time was 6.2 hours. Pathological evaluation revealed a 7.5 cm 68 gm adrenal cortical cancer with tumor thrombus. Soft tissue and adrenal vein margins were negative for cancer. Laparoscopic radical adrenalectomy with en bloc adrenal vein tumor thrombectomy can be exclusively performed intracorporeally, while respecting oncological principles. Essential technical steps include wide margin excision of the adrenal gland, intraoperative ultrasonography, renal vascular control, en bloc tumor thrombectomy and renal venous suture repair in a bloodless field.