Skip to main content
Springer Nature Link
Log in

Laparoscopic adrenalectomy for malignant lesions: surgical principles to improve oncologic outcomes

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Laparoscopic adrenalectomy (LA) is the treatment of choice for benign adrenal lesions. Size of the lesion and radiologic features define the risk for malignancy. In lesions at high risk of malignancy, the experience with the laparoscopic approach is limited and therefore controversial. The purpose of this study was to determine the feasibility and oncological safety of LA for malignant disease.

Methods

Retrospective analysis of prospectively collected database. All LA performed in our department from 2003 to 2011 were reviewed and demographic, perioperative, and follow-up data for those who had malignancy in the final histological report was analyzed. Data are presented as mean ± standard deviation or median (range).

Results

Of 121 LA, we identified 20 patients with 21 malignant adrenal pathologies: 11 primary tumors, 5 adrenocortical carcinoma, 5 large B cell lymphoma, and 1 leiomyosarcoma. Ten metastatic lesions included 5 malignant melanoma (1 patient, both sides), 4 adenocarcinoma, and 1 renal cell carcinoma. There was no conversion to laparotomy. Tumor size was 4.5 (1–9.5) cm, operative duration was 79 (42–262) min, and estimated blood loss was 40 (0–250) ml. All patients resumed regular diet on postoperative day 1, and the median length of stay was 2 days after surgery. Two patients died at 6 and 24 months postoperatively. Three patients were lost to follow-up. All the rest of the patients were disease-free at a follow-up of 58 (7–96) months.

Conclusions

LA for primary or metastatic malignant lesions is feasible and seems oncologically safe. Surgical principles should be the same for all LA: en bloc resection of all epinephric fat, minimal touch technique, and low threshold for conversion. Size of the lesion alone should not be an indication for open surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Gagner M, Lacroix A, Bolte E (1992) Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 327(14):1033

    Article  PubMed  CAS  Google Scholar 

  2. Brunt LM, Doherty GM, Norton JA, Soper NJ, Quasebarth MA, Moley JF (1996) Laparoscopic adrenalectomy compared to open adrenalectomy for benign adrenal neoplasms. J Am Coll Surg 183(1):1–10

    PubMed  CAS  Google Scholar 

  3. Prinz RA (1995) A comparison of laparoscopic and open adrenalectomies. Arch Surg 130(5):489–492

    Article  PubMed  CAS  Google Scholar 

  4. National Institutes of Health (2002) State-of-the-science statement on management of the clinically inapparent adrenal mass (“incidentaloma”). NIH Consens State Sci Statements 19(2):1–25

    Google Scholar 

  5. Jacobs JK, Goldstein RE, Geer RJ (1997) Laparoscopic adrenalectomy. A new standard of care. Ann Surg 225(5):495–501

    Article  PubMed  CAS  Google Scholar 

  6. Wright L, Nordenstrom E, Almquist M (2012) Determinants for malignancy in surgically treated adrenal lesions. Langenbecks Arch Surg 397(2):217–223

    Article  PubMed  Google Scholar 

  7. Kouyama R, Hiraishi K, Sugiyama T, Izumiyama H, Yoshimoto T, Akashi T, Kihara K, Homma K, Shibata H, Hirata Y (2011) Clinicopathological features, biochemical and molecular markers in 5 patients with adrenocortical carcinoma. Endocr J 58(7):527–534

    Article  PubMed  CAS  Google Scholar 

  8. Corcione F, Miranda L, Marzano E, Capasso P, Cuccurullo D, Settembre A, Pirozzi F (2005) Laparoscopic adrenalectomy for malignant neoplasm: our experience in 15 cases. Surg Endosc 19(6):841–844

    Article  PubMed  CAS  Google Scholar 

  9. Zeiger MA, Thompson GB, Duh QY, Hamrahian AH, Angelos P, Elaraj D, Fishman E, Kharlip J, American Association of Clinical Endocrinologists, American Association of Endocrine Surgeons (2009) American association of clinical endocrinologists and American association of endocrine surgeons medical guidelines for the management of adrenal incidentalomas: executive summary of recommendations. Endocr Pract 15(5):450–453

    Article  PubMed  Google Scholar 

  10. Weiss LM, Medeiros LJ, Vickery AL Jr (1989) Pathologic features of prognostic significance in adrenocortical carcinoma. Am J Surg Pathol 13(3):202–206

    Article  PubMed  CAS  Google Scholar 

  11. MacGillivray DC, Whalen GF, Malchoff CD, Oppenheim DS, Shichman SJ (2002) Laparoscopic resection of large adrenal tumors. Ann Surg Oncol 9(5):480–485

    Article  PubMed  Google Scholar 

  12. Henry JF, Sebag F, Iacobone M, Mirallie E (2002) Results of laparoscopic adrenalectomy for large and potentially malignant tumors. World J Surg 26(8):1043–1047

    Article  PubMed  Google Scholar 

  13. Ramacciato G, Mercantini P, La Torre M, Di Benedetto F, Ercolani G, Ravaioli M, Piccoli M, Melotti G (2008) Is laparoscopic adrenalectomy safe and effective for adrenal masses larger than 7 cm? Surg Endosc 22(2):516–521

    Article  PubMed  Google Scholar 

  14. Schteingart DE, Doherty GM, Gauger PG, Giordano TJ, Hammer GD, Korobkin M, Worden FP (2005) Management of patients with adrenal cancer: recommendations of an international consensus conference. Endocr Relat Cancer 12(3):667–680

    Article  PubMed  CAS  Google Scholar 

  15. Shen WT, Sturgeon C, Duh QY (2005) From incidentaloma to adrenocortical carcinoma: the surgical management of adrenal tumors. J Surg Oncol 89(3):186–192

    Article  PubMed  Google Scholar 

  16. Leboulleux S, Deandreis D, Al Ghuzlan A, Aupérin A, Goéré D, Dromain C, Elias D, Caillou B, Travagli JP, De Baere T, Lumbroso J, Young J, Schlumberger M, Baudin E (2010) Adrenocortical carcinoma: is the surgical approach a risk factor of peritoneal carcinomatosis? Eur J Endocrinol 162(6):1147–1153

    Article  PubMed  CAS  Google Scholar 

  17. Miller BS, Ammori JB, Gauger PG, Broome JT, Hammer GD, Doherty GM (2010) Laparoscopic resection is inappropriate in patients with known or suspected adrenocortical carcinoma. World J Surg 34(6):1380–1385

    Article  PubMed  CAS  Google Scholar 

  18. Porpiglia F, Fiori C, Daffara F, Zaggia B, Bollito E, Volante M, Berruti A, Terzolo M (2010) Retrospective evaluation of the outcome of open versus laparoscopic adrenalectomy for stage I and II adrenocortical cancer. Eur Urol 57(5):873–878

    Article  PubMed  Google Scholar 

  19. Brix D, Allolio B, Fenske W, Agha A, Dralle H, Jurowich C, Langer P, Mussack T, Nies C, Riedmiller H, Spahn M, Weismann D, Hahner S, Fassnacht M, German Adrenocortical Carcinoma Registry Group (2010) Laparoscopic versus open adrenalectomy for adrenocortical carcinoma: surgical and oncologic outcome in 152 patients. Eur Urol 58(4):609–615

    Article  PubMed  Google Scholar 

  20. Porpiglia F, Miller BS, Manfredi M, Fiori C, Doherty GM (2011) A debate on laparoscopic versus open adrenalectomy for adrenocortical carcinoma. Horm Cancer 2(6):372–377

    Article  PubMed  Google Scholar 

  21. Carnaille B (2012) Adrenocortical carcinoma: which surgical approach? Langenbecks Arch Surg 397(2):195–199

    Article  PubMed  Google Scholar 

Download references

Disclosures

Drs. Sroka, Slijper, Shteinberg, Mady, Galili, and Matter have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of General Surgery, Bnai-Zion Medical Center, 47 Golomb Street, Haifa, Israel

    Gideon Sroka, Nadav Slijper, Dan Shteinberg, Husam Mady, Ofer Galili & Ibrahim Matter

Authors
  1. Gideon Sroka
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Nadav Slijper
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Dan Shteinberg
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Husam Mady
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Ofer Galili
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Ibrahim Matter
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Gideon Sroka.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sroka, G., Slijper, N., Shteinberg, D. et al. Laparoscopic adrenalectomy for malignant lesions: surgical principles to improve oncologic outcomes. Surg Endosc 27, 2321–2326 (2013). https://doi.org/10.1007/s00464-012-2772-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-012-2772-8

Keywords