The Effect of Hormone Activity and Malignancy on Surgical Parameters in Laparoscopic Adrenalectomy

Öz

Tumours of the adrenal gland can be encountered in various forms ranging from non-hormone-secreting benign adenomas to hormone-secreting malignant adrenocortical carcinomas. This study aimed to investigate the effect of hormone-functional tumours, malignant pathological results and tumour size on surgical and clinical parameters in patients undergoing laparoscopic transperitoneal adrenalectomy. A total of 63 patients who underwent transperitoneal laparoscopic adrenalectomy were included in this study. In the first stage of the study, two groups were formed as hormone-functional adrenal tumours and hormone-non-functional adrenal tumours. In the second stage of the study, the patients were histopathologically divided into 2 groups as malignant and benign adrenal tumours. The effects of hormone activity and malignancy on surgical parameters were investigated in both stages. Mean duration of operation and intraoperative blood loss were higher in the group with malignant pathology (p=0.041, p=0.014, respectively). The duration of operation was shorter in Conn's syndrome compared to the Cushing's syndrome and pheochromocytoma groups (p=0.038). There was a moderate positive correlation between pathological tumour size and duration of operation, which was statistically significant (r=0.449, p<0.001). The success of laparoscopic adrenalectomy is affected by the morphological and functional characteristics of the mass. Prolonged operation times and increased bleeding have been observed in malignant masses. It is esential for surgeons performing the operation to be aware that they may encounter varying clinical presentations both during and after the procedure, depending on the morphological and functional characteristics of the mass.

Anahtar Kelimeler

• Laparoscopy
• Adrenalectomy
• Adrenocortical Carcinoma
• Cushing

Laparoskopik Adrenalektomide Hormon Aktivitesi ve Malignitenin Cerrahi Parametrelere Etkisi

Öz

Adrenal bezdeki tümörlerle, hormon salgılamayan benign adenomlardan, hormon salgılayan malign adrenokortikal karsinomlara kadar değişen şekillerde karşılaşılabilir. Bu çalışmada; hormon fonksiyonel olan tümörlerin, malign patolojik sonuçların ve tümör büyüklüğünün laparoskopik transperitoneal adrenalektomi uygulanan hastalarda, cerrahi ve klinik parametrelere etkisinin araştırılması amaçlanmıştır. Çalışmamıza transperitoneal laparoskopik adrenalektomi operasyonu gerçekleştirilen 63 hasta dahil edildi. Çalışmanın ilk aşamasında, hormon fonksiyonel ve hormon fonksiyonel olmayan adrenal tümörler olarak 2 grup oluşturuldu. Çalışmanın ikinci aşamasında ise histopatolojik olarak malign ve benign adrenal tümörler olarak 2 gruba ayrıldı. Her iki aşamada da hormon aktivitesinin ve malignensinin cerrahi parametrelere etkisi araştırıldı. Ortalama operasyon süresi ve intraoperatif ortalama kan kaybı malign patolojiye sahip grupta daha yüksek izlendi (sırasıyla; p=0.041, p=0.014). Conn sendromunda operasyon süresinin Cushing ve feokromositoma grubuna göre daha kısa olduğu izlendi (p=0.038). Patolojik tümör boyutu ile operasyon süresi arasında orta düzeyde pozitif bir korelasyon olduğu izlendi ve istatistiksel olarak anlamlıydı (r=0.449, p<0.001). Laparoskopik adrenalektomi operasyonunun başarısı kitlenin morfolojik ve fonksiyonel özelliklerinden etkilenmektedir. Malign kitlelerde uzamış operasyon süreleri ve artmış kanama miktarı olduğu gösterilmiştir. Operasyonu gerçekleştirecek cerrahların, kitlenin morfolojik ve fonksiyonel farklılıklarına bağlı olarak operasyon sırasında ve sonrasında farklı klinik tablolarla karşılaşabileceklerini bilmeleri önemli görünmektedir.

Anahtar Kelimeler

• Laparoskopi
• Adrenalektomi
• Adrenokortikal Karsinom
• Cushing Sendromu

Kaynakça

1. 1. Thornton J. Abdominal nephrectomy for large sarcoma of the left suprarenal capsule: recovery. Trans Clin Soc Lond. 1890;23:150-3.
2. 2. Gagner M. Laparoscopic adrenalectomy in Cushing's syndrome and pheochromocytoma. N Engl J Med. 1992;327:1033.
3. 3. Ginzberg SP, Gasior JA, Kelz LR, Passman JE, Ballester JMS, Roses RE, et al. Adrenalectomy approach and outcomes according to surgeon volume. The American Journal of Surgery. 2024;229:44-9.
4. 4. Yip L, Duh Q-Y, Wachtel H, Jimenez C, Sturgeon C, Lee C, et al. American Association of Endocrine Surgeons guidelines for adrenalectomy: executive summary. JAMA surgery. 2022;157(10):870-7.
5. 5. Al-Jalabneh T, Al-Shawabkeh O, Al-Gwairy I, Abu-Zeitoun O, Al-Njadat I, Al-Soudi M, et al. Laparoscopic versus open adrenalectomy: a retrospective comparative study. Medical Archives. 2021;75(1):41.
6. 6. Mete O, Erickson LA, Juhlin CC, de Krijger RR, Sasano H, Volante M, et al. Overview of the 2022 WHO classification of adrenal cortical tumors. Endocrine pathology. 2022;33(1):155-96.
7. 7. Jing Y, Hu J, Luo R, Mao Y, Luo Z, Zhang M, et al. Prevalence and characteristics of adrenal tumors in an unselected screening population: a cross-sectional study. Annals of internal medicine. 2022;175(10):1383-91.
8. 8. Alshahrani MA, Bin Saeedan M, Alkhunaizan T, Aljohani IM, Azzumeea FM. Bilateral adrenal abnormalities: imaging review of different entities. Abdominal Radiology. 2019;44:154-79.

9. 9. Prakobpon T, Santi-Ngamkun A, Usawachintachit M, Ratchanon S, Sowanthip D, Panumatrassamee K. Laparoscopic transperitoneal adrenalectomy in the large adrenal tumor from single center experience. BMC surgery. 2021;21:1-9.
10. 10. Conzo G, Patrone R, Flagiello L, Catauro A, Conzo A, Cacciatore C, et al. Impact of current technology in laparoscopic adrenalectomy: 20 years of experience in the treatment of 254 consecutive clinical cases. Journal of Clinical Medicine. 2023;12(13):4384.
11. 11. Fouche D, Chenais G, Haissaguerre M, Bouriez D, Gronnier C, Collet D, et al. Risk factors for intraoperative complications, postoperative complications, and prolonged length of stay after laparoscopic adrenalectomy by transperitoneal lateral approach: a retrospective cohort study of 547 procedures. Surgical Endoscopy. 2023;37(10):7573-81.
12. 12. Bellantone R, De Crea C. Surgical procedure: adrenalectomy–indications, operative techniques and management of complications. Endocrine Surgery Comprehensive Board Exam Guide: Springer; 2022. p. 575-614.
13. 13. Tiberio GAM, Solaini L, Arru L, Merigo G, Baiocchi GL, Giulini SM. Factors influencing outcomes in laparoscopic adrenal surgery. Langenbeck's archives of surgery. 2013;398:735-43.
14. 14. Zacharias M, Haese A, Jurczok A, Stolzenburg J-U, Fornara P. Transperitoneal laparoscopic adrenalectomy: outline of the preoperative management, surgical approach, and outcome. European urology. 2006;49(3):448-59.
15. 15. Nagesser SK, Kievit J, Hermans J, Krans HMJ, van de Velde CJ. The surgical approach to the adrenal gland: a comparison of the retroperitoneal and the transabdominal routes in 326 operations on 284 patients. Japanese Journal of Clinical Oncology. 2000;30(2):68-74.
16. 16. Aydın YM, Günseren KÖ, Çiçek MÇ, Aslan ÖF, Gül ÖÖ, Cander S, et al. The effect of mass functionality on laparoscopic adrenalectomy outcomes. Langenbeck's Archives of Surgery. 2024;409(1):212.
17. 17. Danwang C, Agbor VN, Bigna JJ. Obesity and postoperative outcomes of the patients with laparoscopic adrenalectomy: a systematic review and meta-analysis. BMC surgery. 2020;20:1-8.
18. 18. Tullavardhana T. Laparoscopic adrenalectomy performed by a general surgeon on functioning adrenal tumors: Treatment outcomes and risk prediction of persistent hypertension. Qatar Medical Journal. 2024;2024(3):30.
19. 19. Vidal O, Saavedra-Perez D, Martos JM, de la Quintana A, Rodriguez JI, Villar J, et al. Risk factors for open conversion of lateral transperitoneal laparoscopic adrenalectomy: retrospective cohort study of the Spanish Adrenal Surgery Group (SASG). Surgical endoscopy. 2020;34:3690-5.
20. 20. Shen Z, Chen S, Wang S, Jin X, Chen J, Zhu Y, et al. Predictive factors for open conversion of laparoscopic adrenalectomy: a 13-year review of 456 cases. Journal of endourology. 2007;21(11):1333-8.
21. 21. McKinlay R, Mastrangelo Jr MJ, Park AE. Laparoscopic adrenalectomy: indications and technique. Current surgery. 2003;60(2):145-9.
22. 22. Li J, Wang Y, Chang X, Han Z. Laparoscopic adrenalectomy (LA) vs open adrenalectomy (OA) for pheochromocytoma (PHEO): a systematic review and meta-analysis. European Journal of Surgical Oncology. 2020;46(6):991-8.
23. 23. Fu S-Q, Wang S-Y, Chen Q, Liu Y-T, Li Z-L, Sun T. Laparoscopic versus open surgery for pheochromocytoma: a meta-analysis. BMC surgery. 2020;20:1-11.
24. 24. Coste T, Caiazzo R, Torres F, Vantyghem MC, Carnaille B, Pattou F, et al. Laparoscopic adrenalectomy by transabdominal lateral approach: 20 years of experience. Surgical endoscopy. 2017;31:2743-51.
25. 25. Donatini G, Caiazzo R, Do Cao C, Aubert S, Zerrweck C, El-Kathib Z, et al. Long-term survival after adrenalectomy for stage I/II adrenocortical carcinoma (ACC): a retrospective comparative cohort study of laparoscopic versus open approach. Annals of surgical oncology. 2014;21:284-91.
26. 26. Sturgeon C, Kebebew E. Laparoscopic adrenalectomy for malignancy. Surgical Clinics. 2004;84(3):755-74.
27. 27. Kastelan D, Knezevic N, Zibar Tomsic K, Alduk AM, Kakarigi L, Kastelan M, et al. Open vs laparoscopic adrenalectomy for localized adrenocortical carcinoma. Clinical endocrinology. 2020;93(4):404-8.
28. 28. Brix D, Allolio B, Fenske W, Agha A, Dralle H, Jurowich C, et al. Laparoscopic versus open adrenalectomy for adrenocortical carcinoma: surgical and oncologic outcome in 152 patients. European urology. 2010;58(4):609-15.
29. 29. Castillo OA, Vitagliano G, Secin FP, Kerkebe M, Arellano L. Laparoscopic adrenalectomy for adrenal masses: does size matter? Urology. 2008;71(6):1138-41.
30. 30. Sharma S, Sharma M, Sarkar C. Morphology of angiogenesis in human cancer: a conceptual overview, histoprognostic perspective and significance of neoangiogenesis. Histopathology. 2005;46(5):481-9.