Synchronous Adrenalectomy Research Articles

PD03-08 SURGICAL AND FUNCTIONAL OUTCOMES OF BILATERAL SYNCHRONOUS ADRENALECTOMY FOR FUNCTIONAL TUMORS: A COHORT STUDY

You have accessJournal of UrologyCME1 Apr 2023PD03-08 SURGICAL AND FUNCTIONAL OUTCOMES OF BILATERAL SYNCHRONOUS ADRENALECTOMY FOR FUNCTIONAL TUMORS: A COHORT STUDY Keshav Agarwal, Rashmi Ramachandran, Nikhil Tandon, and Rajeev Kumar Keshav AgarwalKeshav Agarwal More articles by this author , Rashmi RamachandranRashmi Ramachandran More articles by this author , Nikhil TandonNikhil Tandon More articles by this author , and Rajeev KumarRajeev Kumar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003220.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bilateral synchronous adrenalectomy has the potential for significant surgical and functional morbidity. We reviewed our 15-year experience with bilateral synchronous adrenalectomy to assess safety, surgical outcomes, morbidity and impact on health-related quality of life. METHODS: In an IRB approved study, we reviewed our prospective database of patients who underwent bilateral synchronous adrenalectomy for functional tumours between April 2008 and August 2022. Demographic profile, metabolic and radiological parameters, operative details and complications were recorded. Follow-up was obtained either in-person or telephonically and analysed for resolution of symptoms, quality of life using the WHO-QoL BREF questionnaire and complications of chronic steroid intake. RESULTS: During the study period, 337 adrenalectomies were performed which were bilateral in 51 patients, 48 undergoing both surgeries synchronously. 33 of these 48 patients had bilateral pheochromocytomas and 15 had Cushing’s syndrome. Among patients with Cushing’s syndrome, three had life-threatening symptoms requiring urgent bilateral surgery. Clinical details are given in Table 1. 40 patients had transperitoneal laparoscopic surgery and 8 underwent open surgery (Table 2). There were two intraoperative and 7 post-operative complications. 43 patients were available for follow-up. All had resolution of symptoms, BMI changes, and only two patients continued to receive one antihypertensive medication. Episodes of steroid deficiency occurred in 7 patients while steroid excess occurred in 3 patients. Quality of life was satisfactory in all patients in all domains. CONCLUSIONS: Bilateral synchronous adrenalectomy is safe and feasible in patients with functional adrenal tumors. It leads to symptom resolution with amelioration of hypertension and BMI changes with satisfactory overall quality of life. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e77 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Keshav Agarwal More articles by this author Rashmi Ramachandran More articles by this author Nikhil Tandon More articles by this author Rajeev Kumar More articles by this author Expand All Advertisement PDF downloadLoading ...

Synchronous bilateral laparoscopic adrenalectomy: Surgical technique and perioperative results of a 13-years’ experience

Introduction and objectivesLaparoscopic surgery is the standard approach for the treatment of adrenal glands. Bilateral synchronous adrenalectomy is rarely performed, and evidence about this procedure is limited. Our objective is to report our 13-year experience with synchronous laparoscopic bilateral adrenalectomy, evaluating its feasibility, safety, and perioperative outcomes. Patients and methodsA total of 23 consecutive patients undergoing synchronous bilateral laparoscopic adrenalectomy between 2007 and 2020 in a single academic center were included. Variables evaluated were operative time, estimated blood loss, conversion to open surgery, postoperative complications, mortality, and postoperative length of stay. ResultsMean operative time was 189.3 ± 48.9 min. Mean estimated blood loss was 163.0 ± 201.3 mL. There were no conversions to open surgery. Five patients had postoperative complications, three of those were major. No patient died in the perioperative period. Median postoperative length of stay was three days (range 1−30). At pathology analysis, 15 patients had bilateral adrenal hyperplasia, 2 unilateral adrenal hyperplasia and a contralateral benign tumor, 1 unilateral adrenal hyperplasia and a normal contralateral gland, 1 unilateral adenoma, 3 bilateral pheochromocytomas and 1 bilateral myelolipoma. ConclusionSynchronous bilateral laparoscopic adrenalectomy is a feasible and safe technique. A multidisciplinary and experienced team involving anesthesiologists and endocrinologists is required.

Adrenalectomía laparoscópica bilateral sincrónica: técnica quirúrgica y resultados perioperatorios en 13 años de experiencia

Introduction and objectivesLaparoscopic surgery is the standard approach for the treatment of adrenal glands. Bilateral synchronous adrenalectomy is rarely performed, and evidence about this procedure is limited. Our objective is to report our 13-year experience with synchronous laparoscopic bilateral adrenalectomy, evaluating its feasibility, safety, and perioperative outcomes. Patients and methodsA total of 23 consecutive patients undergoing synchronous bilateral laparoscopic adrenalectomy between 2007 and 2020 in a single academic center were included. Variables evaluated were operative time, estimated blood loss, conversion to open surgery, postoperative complications, mortality, and postoperative length of stay. ResultsMean operative time was 189.3±48.9min. Mean estimated blood loss was 163.0±201.3ml. There were no conversions to open surgery. Five patients had postoperative complications, three of those were major. No patient died in the perioperative period. Median postoperative length of stay was three days (range 1-30). At pathology analysis, 15 patients had bilateral adrenal hyperplasia, 2 unilateral adrenal hyperplasia and a contralateral benign tumor, 1 unilateral adrenal hyperplasia and a normal contralateral gland, 1 unilateral adenoma, 3 bilateral pheochromocytomas and 1 bilateral myelolipoma. ConclusionSynchronous bilateral laparoscopic adrenalectomy is a feasible and safe technique. A multidisciplinary and experienced team involving anesthesiologists and endocrinologists is required.

Incidence of synchronous and metachronous adrenal metastases following tumor nephrectomy in renal cell cancer patients: a retrospective bi-center analysis

IntroductionSynchronous adrenalectomy has become dispensable since retrospective studies have demonstrated no survival benefit when preoperative imaging was normal. The aim of this large bi-institutional study was to determine the appearance of synchronous and metachronous metastases to the adrenal gland as detected by computed tomography and positron emission tomography or magnetic resonance imaging with consecutive surgical removal of suspicious lesions.Materials and methodsWe retrospectively reviewed the clinico-pathological records of 2720 patients from two urological centers who underwent radical or partial nephrectomy due to kidney cancer disease. Synchronous adrenalectomy was carried out in 548 of all cases (20.2%). Metachronous adrenalectomy was performed in 24 cases due to suspicious imaging in follow-up.ResultsMetastatic spread in patients with synchronous adrenalectomy was found in 29/548 cases (5.3%), as suspected. In metachronous procedures positive pathological results were found in 24 of 24 cases. Among them 54% of all tumor recurrences were detected in the contralateral adrenal gland.ConclusionsIn case of preoperative suspicious imaging an intraoperative frozen section should be performed. Radiological investigations are of high diagnostic value for detecting metachronous tumor growth into the adrenal gland. Surgery in this scenario should be recommended due to the high malignancy rate reported here.

Incidence of syn- and metachronous adrenal metastasis following tumor nephrectomy: A retrospective bicenter analysis.

417 Background: Metastases of adrenal gland occur in approximately 1.2 - 10% in kidney cancer patients. Synchronous adrenalectomy has become dispensable since studies have demonstrated no clinical benefit. The aim of this large bi-institutional study was to determine the appearance of syn- and metachronous metastasis to the adrenal gland as detected by CT, PET-CT or MRI imaging with consecutively surgically removal of suspicious lesions. Methods: We retrospectively reviewed the clinical and pathological records of 2308 patients (1200 pts. from Medical School Hanover until 2009 and 1108 pts. from University Hospital Plzeň until 2010) who underwent radical/partial nephrectomy. Synchronous adrenalectomy was carried out in 222 of all cases (10.4%). Metachronous adrenalectomy was performed in 11 cases including 8 ipsilateral and 3 contralateral adrenalectomies due to suspicious imaging among follow-up. In cases of metachronous metastasis pre-operative imaging, surgical and histopathological results were correlated. Results: Metastatic spread in patients with synchronous adrenalectomy was found in 17/222 cases (7.6%), as suspected. In metachronous procedures positive pathological results was found in 10 of 11 (91%) cases. In one case it was a benign pathological result. In all positive cases a metastasis from the former clear cell carcinoma was pathologically confirmed. 27% of all cases were detected in the contralateral adrenal gland. Conclusions: Synchronous adrenalectomy is not routinely recommended with nephrectomy. In case of preoperative suspicious imaging an intraoperative frozen section should be performed. Radiological investigations are of high diagnostic value for detecting metachronous tumor growth within the adrenal gland. Surgery in this scenario should be recommended due to the here reported malignancy rate of 91%.

No Outcome Differences between a Laparoscopic and Retroperitoneoscopic Approach in Synchronous Bilateral Adrenal Surgery

Two main approaches have been described for endoscopic adrenalectomy: the transperitoneal approach with the patient in the lateral decubitus position (LA) and the retroperitoneal approach with the patient in the prone position (ERA). The goal of the present study was to compare the results of LA and ERA for endoscopic bilateral synchronous adrenalectomy. Between 1994 and 2008, 34 patients underwent bilateral synchronous adrenalectomy in two referral centers: 20 patients underwent LA in Pisa (group A), and 14 patients underwent ERA in Halle (group B). Sex, age, preoperative diagnosis, body mass index, preoperative medical treatments, diameter of glands, blood loss, operative time, complications, conversion, intensive care unit stay, day of first oral intake, length of postoperative recovery, histology report, and outcome were analyzed. There were 7 men and 13 women in group A and 6 men and 8 women in group B. Mean age was 48.1 years in group A and 38.9 years in group B. Body mass index was similar in the two groups. Diameters of the glands were larger in group A than in group B, at 61.1 versus 42.8 mm for the right side and 64.1 versus 37.4 mm for the left side. Mean hospital stay was longer in group B (8.2 versus 5.25 days; P = 0.002), whereas the intensive care unit stay was longer in group A (1.44 versus 1 day). It is not possible to determine which of the two approaches is better; both are feasible, safe, and effective and patient outcomes are almost the same.

An audit of nephroureterectomy for upper tract urothelial carcinoma

Background The boundary of nephroureterctomy has been revisited and lymph node dissection has been recommended recently. We investigated the role of synchronous ipsilateral adrenalectomy in treating patients with upper tract urothelial carcinoma. Methods 110 patients with clinically localized upper tract urothelial carcinoma treated by nephroureterectomy and bladder cuff resection were retrospectively evaluated. 70 patients underwent nephroureterectomy without concomitant ipsilateral adrenalectomy, whereas nephroureterectomy and ipsilateral adrenalectomy was performed in other 40 patients. Cancer specific, metastasis and local recurrence free survival during a follow-up of median 46 months were analyzed. Results No patient had adrenal metastasis among the 40 adrenalectomized patients. A total of 4 patients developed local recurrences; including 1 of the 70 adrenalectomy-sparing and 3 of the 40 adrenalectomized patients ( p = 0.102, chi-square test). Five patients with adrenalectomy and four without adrenalectomy had distant metastases ( p = 0.212, chi-square test). The five-year local recurrence free survival ( p = 0.09, log-rank test), metastasis-free survival ( p = 0.292, log-rank test), and cancer-specific survival ( p = 0.117, log-rank test) did not have significant difference between both groups. Conclusions This is the only study in recent 2 decades to evaluate the necessity of synchronous adrenalectomy in treating localized upper tract urothelial carcinoma. Adrenal-sparing nephroureterectomy seems justified for clinically localized upper tract urothelial carcinoma.