Our experience of laparoscopic partial adrenalectomy in surrenal adenomas

Year 2021, Volume: 2 Issue: 3, 71 - 76, 08.09.2021

Murat Baki Yıldırım Fahri Yetişir Mesut Özdedeoğlu Ahmet Gürer Bülent Demirbaş Şemsi Mustafa Aksoy Abdussamed Yalçın Mehmet Kılıç

https://doi.org/10.47582/jompac.943502

Abstract

Aim: For adrenal lesions which are functional and bigger than four centimeters, the optional therapy is surgery. Laparoscopy for the surgery of adrenal masses is increasingly used today. In the past, total adrenalectomy was performed for any adrenal lesions without any exception; however, bilateral involvement of tumors like pheochromocytoma causes trouble and forced surgeons to try partial adrenalectomy. Recently, partial adrenalectomy is a routine surgical procedure for bilateral lesions and also becoming common for unilateral lesions. We aimed to present short-term results for patients who undergo laparoscopic total or partial adrenalectomy.
Material and Method: We collect data retrospectively for 33 patients who were operated on in our clinic for adrenal mass between January 2010 and December 2014. 3 patients were excluded from the study. All data were gained from personal patient medical records. Follow-up records were noted with one-by-one interviews by questioning steroid usage and symptoms of adrenal insufficiency.
Results: Patients were divided into two groups as total adrenalectomy group with 19 patients and partial adrenalectomy group with 11 patients. All patients who underwent total adrenalectomy have unilateral lesions, while 4 for 11 partial adrenalectomy patients have bilateral adrenal masses. Adrenal insufficiency developed in 3 patients for total adrenalectomy, 1 patient for unilateral partial adrenalectomy, and 1 patient for bilateral partial adrenalectomy.
Conclusion: Partial adrenalectomy appears to be protective for adrenal insufficiency for bilateral cases with a ratio of 75%. there was no significant difference between the total or partial unilateral adrenalectomy group, considering postoperative complications, recurrence rates, and insufficiency. As a result, laparoscopic partial adrenalectomy has similar results with less morbidity for unilateral lesions and an alternative method with less adrenal insufficiency for bilateral lesions. Laparoscopic partial adrenalectomy could be performed safely after the learning period was completed and should be considered for adrenal surgeries.

Keywords

adrenalectomy, adrenal insufficiency, cortex sparing surgery, laparoscopy.

Sürrenal adenomlarda laparoskopik parsiyel adrenalektomi deneyimimiz

Abstract

Amaç: Adrenal kitleler fonksiyonel ve 4 cm üzerindeyse ilk tercih adrenalektomidir. Günümüzde adrenal kitlelerin cerrahisi için laparoskopi yaygın olarak kullanılmaktadır. Tarihsel olarak adrenal kitleler için total adrenalektomi uygulanmıştır. Fakat bilateral tutulumu olan feokromasitoma gibi olgular nedeniyle ilk kez parsiyel adrenalektomi gündeme gelmiştir. Günümüzde bilateral olgularda parsiyel adrenalektomi rutin olarak uygulanmakta iken tek taraflı benign lezyonlarda da uygulanması giderek yaygınlaşmaktadır. Bu çalışmada laparoskopik total ve parsiyel adrenalektomi yapmış olduğumuz olguları kısa dönem sonuçlarını sunmayı amaçlıyoruz.
Gereç ve Yöntem: Çalışma Ocak 2010-Aralık 2014 tarihleri arasında adrenal kitle nedenli opere edilen hastaların verileri retrospektif olarak taranması ile yapılmıştır. Belitilen tarihler arasında 33 hastanın sürrenal adenoma nedenli ameliyata alındığı görülmüştür. Çalışmaya dahil edilme kriterlerine uymayan 3 hasta çalışma dışında bırakılmıştır. Çalışmaya dahil edilen 30 hastanın demografik verileri ve yapılan cerrrahi türü hasta dosyalarından öğrenilmiştir. Hastalar kontrole çağırılarak adrenal yetmezlik gelişip gelişmediği ve steroid replasman tedavisi alıp almadıkları sorgulanmıştır.
Bulgular: Çalışmaya alınan 30 hastanın 19’u total adrenalektomi yapıldığı, 11’i parsiyel adrenalektomi yapıldığı görüldü. Total adrenalektomilerinin hepsi unilateral iken parsiyel yapılan ameliyatların 7’si unilateral parsiyel 4’ü bilateral parsiyel adrenalektomi yapılmış olduğu görüldü. Total adrenalektomi yapılan hastaların postoperatif dönemde 3’ünde adrenal yetmezlik gelişirken unilateral parsiyel ve bilateral parsiyel adrenalektomi yapılan hasta gruplarınında birer hastada adrenal yetmezlik geliştiği görüldü.
Sonuçlar: Parsiyel adrenalektomi bilateral olgularda %75 oranında adrenal yetmezlikten korumuştur. Tek taraflı lezyonlarda da nüks, yetmezlik ve peroperatif komplikasyonlar açısından parsiyel ile total arasında fark yoktur. LPA öğrenme eğrisi tamamlandıktan sonra güvenle uygulanabilir. Bilateral adrenalektomi yapılan hastaların çoğunu yetmezlikten korur. Tek taraflı lezyonlarda uygulaması kolay ve hastaya bir zarar vermediği gibi muhtemel faydaları olaçağına inanıyoruz.

Keywords

Parsiyel Adrenalektomi, Korteks Koruyucu Adrenalektomi, Adrenal Yetmezlik

References

• Courtney T, Beauchamp RD, Evers BM, et al. ‘Adrenal Gland Chapter 8’, in Sabiston Textbook of Surgery : The Biological Basis of Modern Surgical Practice, 17th ed. (June 11, 2004)
• Takayanagi R, Miura K, Nakagawa H, Nawata H. Epidemiologic study of adrenal gland disorders in Japan. Biomed Pharmacother 2000; 54: 164-8.
• Lindholm J, Juul S, Jørgensen JO, et al. Incidence and late prognosis of cushing’s syndrome: a population-based study. J Clin Endocrinol Metab 2001; 86: 117-23.
• Terzolo M, Stigliano A, Chiodini I, et al. AME position statement on adrenal incidentaloma. Eur J Endocrinol 2011; 164: 851-70.
• Prager G, Heinz-Peer G, Passler C, et al. Surgical strategy in adrenal masses. Eur J Radiol 2002; 41: 70-7.
• Richard B. Welbourn, Stanley R. et al. ‘The History of Endocrine Surgery by-Praeger-ABC-CLIO’. https: //products.abc-clio.com/abc-cliocorporate/product.aspx?pc=C9005C (accessed May 23, 2021).
• Gagner M, Lacroix A, Bolté E. Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 1992; 327: 1033.
• Ip JCY, Lee JC, Sidhu SB. Laparoscopic adrenalectomy: the transperitoneal approach. Curr Surg Rep 2013; 1: 26-33.
• Schteingart DE, Doherty GM, Gauger PG, et al. Management of patients with adrenal cancer: recommendations of an international consensus conference. Endocr Relat Cancer 2005; 12: 667-80.
• Prager G, Heinz-Peer G, Passler C, Kaczirek K, Scheuba C, Niederle B. Applicability of laparoscopic adrenalectomy in a prospective study in 150 consecutive patients. Arch Surg 2004; 139: 46–9.
• Prager G, Heinz-Peer G, Passler C, Kaczirek K, Scheuba C, Niederle B. Applicability of laparoscopic adrenalectomy in a prospective study in 150 consecutive patients. Arch Surg 2004; 139: 46-9.
• Brix D, Allolio B, Fenske W, et al. Laparoscopic versus open adrenalectomy for adrenocortical carcinoma: surgical and oncologic outcome in 152 patients. Eur Urol 2010; 58: 609-15.
• McCauley LR, Nguyen MM. Laparoscopic radical adrenalectomy for cancer: long-term outcomes. Curr Opin Urol 2008; 18: 134-8.
• Porpiglia F, Fiori C, Daffara F, et al. Retrospective evaluation of the outcome of open versus laparoscopic adrenalectomy for stage I and II adrenocortical cancer. Eur Urol 2010; 57: 873-8.
• Neumann HP, Reincke M, Bender BU, Elsner R, Janetschek G. Preserved adrenocortical function after laparoscopic bilateral adrenal sparing surgery for hereditary pheochromocytoma. J Clin Endocrinol Metab 1999; 84: 2608-10.
• Asari R, Scheuba C, Kaczirek K, Niederle B. Estimated risk of pheochromocytoma recurrence after adrenal-sparing surgery in patients with multiple endocrine neoplasia type 2A. Arch Surg 2006; 141: 1199-205.
• ‘Adrenalectomy, Open And Minimal invazive’, in Mastery of Surgery, Fifth Edition, 5th ed., 2011; pp. 458–62.
• Elfenbein DM, Scarborough JE, Speicher PJ, Scheri RP. Comparison of laparoscopic versus open adrenalectomy: results from American College of Surgeons-National Surgery Quality Improvement Project. J Surg Res 2013; 184: 216-20.
• Durhan A , Süleyman M . Evaluation of the clinical indications and surgical methods in patients who underwent adrenalectomy. Ankara Eğitim ve Araştırma Hastanesi Tıp Derg 2021; 54: 117-22.
• Kazaryan AM, Marangos IP, Rosseland AR, et al. Laparoscopic adrenalectomy: Norwegian single-center experience of 242 procedures. J Laparoendosc Adv Surg Tech A 2009; 19: 181-9.
• Tatsugami K, Eto M, Hamaguchi M, Yokomizo A, Harano M, Naito S. What affects the results of a laparoscopic adrenalectomy for pheochromocytoma? Evaluation with respect to intraoperative blood pressure and state of tumor. J Endourol 2009; 23: 101-5.
• Higashihara E, Baba S, Nakagawa K, et al. Learning curve and conversion to open surgery in cases of laparoscopic adrenalectomy and nephrectomy. J Urol 1998; 159: 650-3.
• Kazama I, Komatsu Y, Ohiwa T, Sanayama K, Nagata M. Delayed adrenal insufficiency long after unilateral adrenalectomy: prolonged glucocorticoid therapy reduced reserved secretory capacity of cortisol. Int J Urol 2005; 12: 574-7.
• Di Dalmazi G, Berr CM, Fassnacht M, Beuschlein F, Reincke M. Adrenal function after adrenalectomy for subclinical hypercortisolism and Cushing’s syndrome: a systematic review of the literature. J Clin Endocrinol Metab 2014; 99: 2637-45.
• Hawn MT, Cook D, Deveney C, Sheppard BC. Quality of life after laparoscopic bilateral adrenalectomy for Cushing’s disease. Surgery 2002; 132: 1064-9.
• DeFronzo RA. Hyperkalemia and hyporeninemic hypoaldosteronism. Kidney Int 1980; 17: 118-34.
• Nagaraja V, Eslick GD, Edirimanne S. Recurrence and functional outcomes of partial adrenalectomy: a systematic review and meta-analysis. Int J Surg 2015; 16: 7-13.
• Irvin GL 3rd, Fishman LM, Sher JA. Familial pheochromocytoma. Surgery 1983; 94: 938-40.
• Lee JE, Curley SA, Gagel RF, Evans DB, Hickey RC. Cortical-sparing adrenalectomy for patients with bilateral pheochromocytoma. Surgery 1996; 120: 1064-71.
• Janetschek G, Lhotta K, Gasser R, Finkenstedt G, Jaschke W, Bartsch G. Adrenal-sparing laparoscopic surgery for aldosterone-producing adenoma. J Endourol 1997; 11: 145-8.
• Walz MK, Peitgen K, Diesing D, et al. Partial versus total adrenalectomy by the posterior retroperitoneoscopic approach: early and long-term results of 325 consecutive procedures in primary adrenal neoplasias. World J Surg 2004; 28: 1323-9.
• Brauckhoff M, Nguyen Thanh P, Bär A, Dralle H. Subtotale bilaterale Adrenalektomie mit adrenokortikalem Funktionserhalt [Subtotal bilateral adrenalectomy preserving adrenocortical function]. Chirurg 2003; 74: 646-51.
• Di Dalmazi G, Berr CM, Fassnacht M, Beuschlein F, Reincke M. Adrenal function after adrenalectomy for subclinical hypercortisolism and Cushing’s syndrome: a systematic review of the literature. J Clin Endocrinol Metab 2014; 99: 2637-45.
• Skalkeas G, Gogas JG, Sechas MN, Kostakis A, Pavlatos F. Cushing’s syndrome. Analysis of 18 cases. Am J Surg 1982; 143: 363-6.
• Lal G, Duh QY. Laparoscopic adrenalectomy--indications and technique. Surg Oncol 2003; 12: 105-23.
• Kaye DR, Storey BB, Pacak K, Pinto PA, Linehan WM, Bratslavsky G. Partial adrenalectomy: underused first line therapy for small adrenal tumors. J Urol 2010; 184: 18-25.
• Kok KY, Yapp SK. Laparoscopic adrenal-sparing surgery for primary hyperaldosteronism due to aldosterone-producing adenoma. Surg Endosc 2002; 16: 108-11.
• Jeschke K, Janetschek G, Peschel R, Schellander L, Bartsch G, Henning K. Laparoscopic partial adrenalectomy in patients with aldosterone-producing adenomas: indications, technique, and results. Urology 2003; 61: 69-72.
• Nambirajan T, Leeb K, Neumann HP, Graubner UB, Janetschek G. Laparoscopic adrenal surgery for recurrent tumours in patients with hereditary phaeochromocytoma. Eur Urol 2005; 47: 622-6.
• Ishidoya S, Ito A, Sakai K, et al. Laparoscopic partial versus total adrenalectomy for aldosterone producing adenoma. J Urol 2005; 174: 40-3.