Laparoscopic Adrenalectomy in Children for Neuroblastoma (original) (raw)
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Laparoscopic treatment of adrenal masses in children: Report of two cases and review of literature
African journal of paediatric surgery : AJPS
Laparoscopic adrenalectomy has become a common alternative to open surgery for the resection of adrenal lesions in adults: The advantages are to provide better exposure of the adrenal gland, diminish soft tissue dissection, decrease morbidity and postoperative pain; however, reporting on the laparoscopic adrenalectomy in paediatric patients has been limited. We present two cases of laparoscopic adrenalectomy performed at our institution in two children, for left adrenal neuroblastoma in a first patient with opsomyoclonus syndrome, and for a right incidentaloma in the second case. According to recent literature, our experience has demonstrated that the laparoscopic adrenalectomy is a feasible procedure in children with small, well-circumscribed adrenal masses: It can be used a safety to treat suspected benign and malignant adrenal masses in children, with minimal morbidity and short hospital stay. The lateral trans-peritoneal approach offers optimal visualisation and good outcomes in...
Minimally Invasive Surgery for Pediatric Adrenal Masses—Report on Four Cases
European Journal of Pediatric Surgery Reports, 2019
The dignity of adrenal masses in children varies from benign lesions like adenoma and ganglioneuroma to malignant tumors like adrenocortical carcinoma and neuroblastoma. Any surgical approach, especially minimally invasive surgery (MIS), requires careful risk stratification based on oncological and technical criteria. Herein, we present four patients who underwent MIS for adrenal masses. Laboratory testing differentiated between simple cysts and adenoma, but could not identify a child with adrenocortical tumor preoperatively. Analysis of image-defined risk factors excluded vascular encasement in all cases. All patients underwent laparoscopic adrenalectomy without complications. Histopathology revealed simple cyst, ganglioneuroblastoma, adenoma, and potentially malignant adrenocortical tumor in one patient/case each. All specimen showed clear margins and no recurrence was noted at a mean follow-up of 18 months.
Long-term Outcome following Laparoscopic Adrenalectomy for Large Solid Adrenal Cortex Tumors
World Journal of Surgery, 2006
Introduction: Laparoscopic adrenalectomy (LA) is the procedure of choice for small benign adrenal tumors. In the absence of local invasion or metastases, the preoperative diagnosis of an adrenocortical carcinoma (ACC) is difficult, often leaving size as the principal predictor of malignancy. Large tumors are resectable laparoscopically, but the long-term outcome and therefore appropriateness of LA for cortical tumors > 6 cm is not known. Methods: We reviewed the LA experience in our institution since its introduction in June 1994. Patients who underwent LA for solid cortical tumors ‡ 60 mm in diameter without preoperative or intraoperative evidence of malignancy were reviewed. Follow-up data, including clinical examination, biochemical analysis, and repeat scans, were reviewed for evidence of local or systemic recurrent disease. Results: Between 1994 and 2004 a total of 462 adrenalectomies were performed, 391 of which were done laparoscopically. Among them, 19 were solid cortical tumors ‡ 60 mm in diameter with no overt malignant preoperative or intraoperative characteristics: 9 nonsecreting tumors, 8 Cushing's syndrome tumors (including 2 virilizing variants), 1 virilizing tumor, and 1 aldosteronoma. The mean age of the patients was 49.9 years (range 22-77 years), and the mean tumor size was 69.0 mm (range 60-80 mm). Histology confirmed a cortical adenoma in eight patients, malignant tumors in three, and indeterminate tumors in eight. The mean follow-up was 34 months (range 4-108 months). Two patients died of systemic recurrent disease (liver metastases) at 10 and 19 months, respectively, following surgery; two other patients died 12 and 21 months, respectively following surgery owing to unrelated cardiovascular and cerebrovascular pathology. One patient underwent surgery for local recurrence 54 months after primary surgery; the remaining 14 patients are well with no clinical or radiologic evidence of recurrent disease. Conclusions: Laparoscopic adrenalectomy for large solid cortical tumors without pre-or intraoperative evidence of malignancy is not contraindicated, and it is unlikely to have a deleterious effect on long-term outcome. Each case should be considered individually. We provide an algorithm for the approach to adrenocortical tumors ‡ 6 cm.
Laparoscopic surgery for adrenal tumors. A retrospective analysis
HORMONES, 2006
OBJECTIVE. Laparoscopic adrenalectomy has rapidly replaced open adrenalectomy as the procedure of choice for benign adrenal tumors. The aim of this study was to evaluate the shortand long-term results of 100 consecutive laparoscopic and open adrenalectomies performed during a period of 8.5 years in our Surgical Unit. DESIGN. A retrospective analysis of patients operated on for adrenal tumors was conducted. From May 1997 to August 2005, one hundred adrenalectomies were performed on 95 patients. Five patients underwent either synchronous or metachronous bilateral adrenalectomy. There were 38 men and 57 women, aged 16 to 80 years. The size of tumors in our series ranged from 3.2 to 27 cm. The largest laparoscopically excised tumor was a ganglioneuroma with a diameter of 13 cm. RESULTS. In 73 patients laparoscopic procedure was completed successfully. In 8 cases the laparoscopic procedure was converted to open. Fourteen patients were treated with open approach. One patient with pheochromocytoma succumbed following pulmonary embolus. In one patient with morbid obesity, Cushings syndrome, and bilateral adrenal macronodular hyperplasia, the left laparoscopic adrenalectomy was complicated by a low output pancreatic fistula, conservatively treated. All other patients had an uneventful course. Operative time for laparoscopic adrenalectomies ranged from 65 to 180 minutes. The average postoperative hospital stay for laparoscopic adrenalectomy ranged from 1 to 2 days (1.5 days), versus 5 to 20 days for patients who underwent open or converted procedure. CONCLUSIONS: Laparoscopic adrenalectomy should be the treatment of choice for all benign adrenal tumors. Laparoscopic resection of large adrenal tumors necessitates experience in open and advanced laparoscopic surgery.
European Urology, 2010
Introduction: Earlier reports of laparoscopic adrenalectomy (LA) for adrenal myelolipoma are limited. Presentation of case: Between June 2000 and September 2012, we performed right adrenal resections using LA and open adrenalectomy (OA) in patients with myelolipoma (n ¼ 3 and n ¼ 3, respectively). Then, we evaluated patients' background characteristics and short-and long-term outcomes for both groups. The median maximum diameters of tumors were 3.5 (3.0e4.4) cm and 7.1 (7.0e9.5) cm for the LA and OA groups, respectively. The median durations of the operation were 152 (117e188) min and 218 (153e230) min, and the median blood loss volumes were 50 (20e160) mL and 290 (62e1237) mL in the LA and OA groups, respectively. The median postoperative lengths of hospital stay were 4 (4e4) days and 11 (11e13) days for the LA and OA groups, respectively. Conversion from LA to an open approach during surgery was not necessary in any of the cases. Additionally, perioperative morbidity and mortality were not observed. Discussion: The limitation of this study is its methodological design; it is a case series and not a matchedcontrol study, which would be difficult to conduct owing to the rare nature of adrenal myelolipoma. However, we esteem that LA will become widespread in the future because it is feasible, cosmetic, and less invasive. Conclusion: LA was a safe, feasible, and effective approach to adrenal myelolipoma, assisted by advancement in preoperative imaging diagnostic techniques.
Laparoscopic adrenalectomy for malignant tumors
International Journal of Urology, 2008
The treatment of malignant adrenal tumors using laparoscopic surgery remains controversial. We thus compared the perioperative outcome of the laparoscopic adrenalectomy for the treatment of malignant tumors with the outcome for benign tumors. We also evaluated the oncological outcome of the laparoscopic adrenalectomy for a malignancy. Methods: Since 1999 a total of nine laparoscopic adrenalectomies for a malignancy have been performed in nine patients. The median adrenal tumor size was 3 cm. The laparoscopic approach was transperitoneal in all cases. Seven patients had no evidence of a systemic metastatic disease, whereas two patients with a metastatic renal cell carcinoma had systemic metastatic disease at the time of the operation. Results: The median operation time was 165 min and the estimated blood loss was 75 mL in the laparoscopic adrenalectomy for a malignancy. There was no significant difference between laparoscopic adrenalectomy for malignant and benign tumors. Regarding the oncological outcome, seven of the nine patients, including the two palliative cases, treated with a laparoscopic adrenalectomy for a malignancy were alive at a median follow-up of 20 months. One patient died of other causes. Conclusions: Our results clearly indicate that a laparoscopic adrenalectomy for the treatment of a metastatic adrenal malignancy can be performed with an acceptable outcome as a minimally invasive method in carefully selected patients.
Ain Shams Journal of Surgery, 2016
Demographic data, operative findings, operative complications, postoperative complications, and duration of hospital stay were recorded and compared in both groups. Results: Two groups of patients (18 in each group) were allocated in this study. Both groups were statistically similar regarding age, gender, body mass index (BMI), and American Society of Anesthesiologists (ASA) score. Two patients in the laparoscopic group were converted to open resection. The mean operative time in the laparoscopic group was significantly higher. However, the mean operative blood loss, need for analgesics, time of passing flatus after surgery, the duration of hospital stay were significantly lower in the laparoscopic group. Postoperative complications, hemodynamic stability and need for blood transfusion showed no statistical difference in both groups. Conclusions: Laparoscopic adrenalectomy is a safe operative procedure offering faster recovery, and shorter hospital stay. Hence, we recommend laparoscopic adrenalectomy as the first line treatment for benign adrenal masses less than 6 cm in size.
Laparoscopic adrenalectomy for adrenal masses in children
Journal of Pediatric Urology, 2011
Objective: The laparoscopic approach to the adrenal gland was first reported in 1992. Since then numerous studies have been published, comprising of adults. Experience with the laparoscopic technique for adrenal disease in children and adolescents has been limited. We have reviewed our experience with laparoscopic adrenal surgery in children. Patients and methods: All children with pathologic adrenal masses undergoing laparoscopic adrenal surgery were included. The primary study outcome measures included operative time, conversion to open surgery, complications, duration of hospital stay and outcome of surgery. Results: Eighteen children underwent laparoscopic adrenalectomy during the period January 2003eJuly 2009. The mean operating time was 95 min, mean blood loss was 30 ml and the average postoperative hospital stay was 50 h. There were no conversions to open surgery and no major intra-or postoperative complications noted. Conclusions: Laparoscopic adrenalectomy is a safe and feasible procedure with good results. It can be used to safely treat suspected benign and malignant adrenal masses in children with minimal morbidity and a shorter hospital stay.
Laparoscopic adrenalectomy for large solid cortical tumours--is it appropriate?
Chirurgia (Bucharest, Romania : 1990)
Laparoscopic adrenalectomy, the procedure of choice for small benign adrenal tumours, is also used for large tumours. Our study aims to assess the outcome of large adrenal tumours laparoscopically resected. All patients with laparoscopic adrenalectomy performed in between 2002 and 2009, without preoperative or intraoperative malignant characteristics, were reviewed. Clinical, biochemical and CT follow-up data were reviewed for evidence of recurrent disease. Fifty patients underwent laparoscopic adrenalectomies in our unit, 18 of them having solid cortical tumours > or = 7 cm without preoperative or intraoperative malignant features: 6 Cushing's syndrome tumours, 8 non-secreting tumours, 4 aldosteronomas. The mean age of the patients was 46.89 years (range 22-64 years), and the mean tumour size 7.57 cm (range 7-9.1 cm). Histology identified 10 cortical adenomas, 4 malignant tumours, and 4 indeterminate tumours. The mean - follow-up was 28.94 months (range 4-58 months). Three p...