Laparoscopic Versus Open Adrenalectomy for Adrenocortical Carcinoma: Surgical and Oncologic Outcome in 152 Patients (original) (raw)
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Adrenal Myelolipoma: Operative Indications and Outcomes
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2014
Background: Adrenal myelolipoma (AM) is a benign lesion for which adrenalectomy is infrequently indicated. We investigated operative indications and outcomes for AM in a large single-institution series. Subjects and Methods: A retrospective cohort study of prospectively collected data was conducted. Patients (q16 years of age) who underwent adrenalectomy in the Division of General Surgery at Barnes-Jewish Hospital (1993-2010) were grouped by operative indication (myelolipoma versus other pathology) and compared using nonparametric tests (a < 0.05). Results: Sixteen patients (4.0%) had myelolipomas resected out of 402 patients who underwent adrenalectomy. Fourteen patients with suspected AM underwent adrenalectomy, 13 (93%) of whom had AM confirmed on pathology. Indications for adrenalectomy were abdominal or flank pain, large tumor size (>8 cm), atypical radiologic appearance, and/or inferior vena cava compression. Three patients with suspected other adrenal lesions had AM confirmed on final pathology. Operative approach was laparoscopic in 15 cases and open in 1 case of a 21-cm lesion. Patients who underwent laparoscopic adrenalectomy for AM (n = 15) or other adrenal pathology (n = 343) were similar with respect to age, gender, American Society of Anesthesiologists classification, prior abdominal operation, tumor side, operative time, conversion rate, estimated blood loss, intraoperative complications, hospital length of stay, and 30-day morbidity. However, patients with resected AM had a higher body mass index (36.5-8.1 kg/m 2 versus 30.1-7.5 kg/m 2 ; P < .01) and a larger preoperative tumor size (8.4-3.0 cm versus 3.1-1.7 cm; P < .01). Conclusions: Laparoscopic adrenalectomy may be appropriate for patients with a presumptive diagnosis of AM and abdominal or flank pain, large tumor size, and/or uncertain diagnosis after imaging. Outcomes and morbidity following LA for AM and other adrenal pathology appear comparable.
Laparoscopic adrenalectomy for adrenal myelolipoma
Archivos Españoles de Urología (Ed. impresa), 2007
OBJETIVE: To evaluate the results of laparoscopic adrenalectomy for adrenal myelolipoma in a single center. METHODS: Between November 1999 and February 2006, 226 laparoscopic adrenalectomies were performed at our institution. 19 specimens corresponded with adrenal myelolipomas (8%). Mean patient age was 53.8 years (range 35 to 75) with male-to-female ratio 2:1. Clinical data was prospectively collected. Patient characteristics, lesion size evaluated by CT scan or MRI, surgical technique, operative time, operative blood loss, complications, conversion to open surgery and hospital stay were reviewed. Resumen.-Evaluar los resultados de la adrenalectomía laparoscópica por mielolipoma suprarrenal en un único centro. MÉTODOS: Entre noviembre de 1999 y febrero del 2006 se realizaron 226 adrenalectomías laparoscópicas en nuestra institución. Diecinueve casos fueron mielolipomas (8%). La edad media de los pacientes fue de 53,8 años (rango de 35 a 75) con una relación varónes: mujeres de 2:1. Los datos clínicos se recogieron de forma prospectiva. Se revisan las características del paciente, tamaño de la lesión evaluado por TAC o re-
Giant Adrenal Myelolipoma: Is Laparoscopic Resection Possible?
2020
Background: Myelolipoma is a benign and uncommon tumor of the adrenal gland. The majority is small and asymptomatic and is diagnosed incidentally. However it can be large and produce symptoms. The laparoscopic adrenalectomy is the gold standard for its treatment but can be challenging if the lesion is big because of technical aspects and the associated malignancy risk. Case Report: We present a case of an asymptomatic 37 years old man, with past history of arterial hypertension, that performed an abdominal ultrasound that showed a huge mass on the right adrenal gland with 98×85×96 mm, consistent with a myelolipoma. The abdomino-pelvic tomography confirmed the diagnosis and the functional study revealed a marginal elevation of plasmatic nor-adrenaline and catecholamines. The MIBG scintigraphy was normal. The lesion was removed by laparoscopy. Conclusion: The giant adrenal myelolipoma is a rare tumor. Laparoscopic adrenalectomy has become the gold standard in management of most adrenal masses. Even for giant adrenal masses, it can be done in a safe way, provided that is performed by an experienced laparoscopic team.
Laparoscopic excision of a giant adrenal myelolipoma and review of the literature
African Journal of Urology
Introduction: Adrenal myelolipoma is a rare benign tumor. It is usually asymptomatic with variable sizes, where the small lesions are usually managed conservatively and the large and symptomatic ones indicate open or laparoscopic adrenalectomy. Observation: A 45-year-old obese male patient presented with an accidentally-discovered right adrenal mass during abdominal sonographic examination. The mass was clinically-palpable in the right lumbar region. Abdominal computed tomography described a well-circumscribed lesion displacing the right kidney downwards with compression and displacement of the inferior vena cava. It was heterogeneous with 16 cm × 14 cm × 8 cm dimensions and low attenuation appearance. Adrenal myelolipoma was suspected and the patient was counseled for the laparoscopic approach with high possibilities of conversion to open surgery. Laparoscopic excision was done by expert surgeons with demanding dissection from the surroundings, especially the liver and inferior vena cava, but, the mass was successfully removed. The postoperative course was short and uneventful. Histopathological examination confirmed the diagnosis of adrenal myelolipoma.
Diagnosis and Management of a Large Adrenal Myelolipoma
International Journal of Recent Surgical and Medical Sciences
Adrenal myelolipoma is a rare condition. Although benign in nature, these tumors can increase in size and cause a mass effect to nearby structures presenting as abdominal distension and pain. In 90% of cases, adrenal myelolipomas are unilateral. However, the real challenge in management is when bilateral adrenal myelolipoma is present. Herein, we present a case of a 51-year-old male Caucasian patient with bilateral adrenal myelolipoma. The patient had a large left adrenal myelolipoma (23 × 13 cm) and a small one on the right (4.4 × 4 cm). We opted for an open left adrenalectomy due to classical features on computed tomography scan and the mass effect of the tumor.
Adrenal myelolipoma: To operate or not? A case report and review of the literature
International journal of surgery case reports, 2014
Myelolipoma is a rare, benign neoplasm that predominantly occurs in the adrenal gland and is composed of mature adipose tissue and scattered islands of hematopoietic elements. Although usually small and asymptomatic, there are some cases of adrenal myelolipoma that cause symptoms such as chronic pain. Elective surgery can prevent a more severe symptom presentation and life threatening progression while also allowing accurate diagnosis in patients with tumors larger than 6cm. This report presents an unusual case of a 28-year-old female who suffered with chronic pain from a growing left-sided adrenal myelolipoma. Without the financial means for additional testing along with many symptoms warranting a high suspicion for malignancy, this patient decided to have the mass surgically excised, which was both diagnostic and curative. For this specific patient, surgery was the most cost effective option, as well as both diagnostic and curative. Surgery can also prevent complications such as s...
Adrenal myelolipoma: Controversies in its management
Indian Journal of Urology, 2015
Adrenal myelolipomas (AMLs) are rare, benign neoplasms of the adrenal gland with varied clinical presentations. The rarity of these tumors precludes any case-controlled or randomized study into their management. The available literature is limited to case reports and short series from referral centers. This review is an effort to put the available literature into perspective such that clinical decision making can be done with some clarity. The PubMed and Cochrane databases were searched with key words Adrenal Myelolipoma, Adrenal Incidentaloma (AI) and Adrenal Collision Tumor (ACT). From over 1300 search results, 547 relevant publications dating from 1954 to 2014 were reviewed. Details of about 1231 AMLs in the indexed literature were analyzed. Increasing usage of imaging studies has significantly increased the discovery of AMLs. Although AMLs are benign tumors, those measuring larger than 6 cm are prone to rupture and hemorrhage. Thorough endocrine work-up may benefit a selected group of patients, especially those who are hypertensive, diabetic/pre-diabetic, young patients (<50 years) and those with bilateral AML. Regular observation is needed for AML patients who are being treated non-operatively, as many of them may require surgery during follow-up. Although the AACE/AAES guidelines for AI (2009) exclude AML from mandatory metabolic work-up for a newly discovered AI, we feel that a significant number of patients with AML would benefit from metabolic work-up. In the literature, endocrine dysfunction in AML is 7% as compared with 11% in AI. Endocrine dysfunction in AML is probably underdiagnosed.
Chirurgia, 2017
Incidenţa mielolipoamelor în cadrul tumorilor primare de glandă suprarenală este de 3-7% şi de cele mai multe ori acestea sunt incidentaloame. În majoritatea situaţiilor sunt asimptomatice, rareori simptomatice (dureri, discomfort abdominal, hematurie sau semne de hemoragie internă). Histologic benigne, această varietate de tumori necesită doar excizie locală în formele simptomatice. Dimensiunile lor sunt în general până la 4-5 cm, de aceea abordul laparoscopic pare cel mai indicat. Se prezintă cazul unei paciente în vârstă de 65 de ani, operată electiv pentru o formaţiune tumorală suprarenaliană dreaptă la care s-a practicat o adrenalectomie dreaptă laparoscopică prin abord transabdominal anterior. Nu s-au utilizat ligaturi, clipuri sau suturi, intervenţia realizându-se cu pensa Ligasure Maryland şi platforma Force Triad (Covidien Medtronic-USA). Evoluţia postoperatorie a fost favorabilă, examenul histopatologic evidenţiind un mielolipom adrenal cu hemoragie intratumorală.
Adrenal myelolipoma: diagnosis and management
Urology journal, 2006
Adrenal myelolipomas are benign lesions that contain hematopoietic and fatty elements. They are usually hormonally inactive and asymptomatic until they reach large sizes. With the routine use of cross-sectional imaging, these lesions are now being discovered with increasing frequency. We performed a comprehensive review of the literature using the PubMed database containing the key word adrenal myelolipoma. We identified 492 articles written from 1956 to 2006 and reviewed 93 in detail including the authors' own experience. In this review, we highlighted the salient diagnostic features of adrenal myelolipomas and offered a guide for management of these benign lesions. Adrenal myelolipomas may grow over time, but they can usually be followed without surgical excision. In some cases, very large myelolipomas can present with pain and can be confused with necrotic adrenal carcinomas, thus necessitating their surgical removal.
Review Articles Adrenal Myelolipoma: Diagnosis and Management
2006
Introduction: Adrenal myelolipomas are benign lesions that contain hematopoietic and fatty elements. They are usually hormonally inactive and asymptomatic until they reach large sizes. With the routine use of cross-sectional imaging, these lesions are now being discovered with increasing frequency. Materials and Methods: We performed a comprehensive review of the literature using the PubMed database containing the key word adrenal myelolipoma. Results: We identified 492 articles written from 1956 to 2006 and reviewed 93 in detail including the authors' own experience. In this review, we highlighted the salient diagnostic features of adrenal myelolipomas and offered a guide for management of these benign lesions. Conclusion: Adrenal myelolipomas may grow over time, but they can usually be followed without surgical excision. In some cases, very large myelolipomas can present with pain and can be confused with necrotic adrenal carcinomas, thus necessitating their surgical removal.