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1
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Kong J, Odisho T, Alhajahjeh A, Maqsood HA, Al-Share BA, Shahait M, Abubaker A, Kim S, Shahait A. Long-term survival following adrenalectomy for secondary adrenal tumors: A systematic review and meta-analysis. Am J Surg 2024; 237:115809. [PMID: 38945726 DOI: 10.1016/j.amjsurg.2024.115809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 06/04/2024] [Accepted: 06/25/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Secondary adrenal tumors (SATs) are uncommon, and the benefits of adrenalectomy for SATs have not been well-established. A systematic review and meta-analysis were conducted to assess the survival benefits of adrenalectomy for SATs. METHOD ology: A systematic literature search was performed (1990-2022). The inclusion criteria included a known primary tumor with confirmed adrenal metastasis in patients who underwent adrenalectomy. The primary outcome was the overall survival (OS). RESULTS A total of 26 studies were included, with 2279 patients. The average age at the time of diagnosis was 61.1 years. Lung cancer was the most common primary tumor. The average time from primary tumor diagnosis to identification of adrenal metastasis was 17 months. The median OS was 35.2 months. One, three, and five-year OS were 79.7 %, 49.1 %, and 37.9 %, respectively. CONCLUSION The results of this review provide insight into the long-term survival of patients with SATs who underwent adrenalectomy. The study highlights the need for further research to identify the risk factors that play a role in the outcome of adrenalectomy in patients with SATs.
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Affiliation(s)
- Joshua Kong
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Tanya Odisho
- Department of Surgery, Detroit Medical Center, Detroit, MI, USA
| | | | | | - Bayan A Al-Share
- Monument Health Cancer Care Institute, Monument Health Rapid City Hospital, SD, USA
| | - Mohammed Shahait
- Urology and Robotic Surgery Consultant, Dubai, United Arab Emirates
| | - Ali Abubaker
- Department of Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Steve Kim
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Awni Shahait
- Southern Illinois University School of Medicine, Carbondale, IL, USA.
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2
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Laparoscopic adrenalectomy for adrenal metastases of solid tumors. Surg Endosc 2023:10.1007/s00464-023-09961-4. [PMID: 36869264 DOI: 10.1007/s00464-023-09961-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/12/2023] [Indexed: 03/05/2023]
Abstract
INTRODUCTION In patients with history of cancer adrenal metastases can be found in up to 70% of adrenal tumors detected during follow-up. Currently, laparoscopic adrenalectomy (LA) is considered the gold standard approach for benign adrenal tumors but is still controversial in malignant disease. Depending on the patient's oncological status, adrenalectomy might be a possible treatment option. Our objective was to analyze the results of LA for adrenal metastasis from solid tumors in two referral centers. METHODS Retrospective analysis of 17 patients with non-primary adrenal malignancy treated with LA between 2007 and 2019 was performed. Demographic and primary tumor data, type of metastasis, morbidity, disease recurrence and evolution were evaluated. Patients were compared according to type of metastases: synchronous (< 6 months) vs metachronous (≥ 6 months). RESULTS 17 patients were included. Median metastatic adrenal tumor size was 4 cm (IQR, 3-5.4). We had one conversion to open surgery. Recurrence was found in 6 patients with one recurring in the adrenal bed. The median OS was 24 (IQR, 10.5-60.5) months and 5-year OS was 61.4% (95%CI: 36.7%-81.4%). Patients with metachronous metastases had better overall survival vs. patients with synchronous metastases (87% vs. 14%, p = 0.0037). CONCLUSION LA for adrenal metastases is a procedure associated with low morbidity and acceptable oncologic outcomes. Based on our results, seems reasonable to offer this procedure to carefully selected patients, mainly those with metachronous presentation. Indication of LA must be done on a case by case evaluation in the context of a multidisciplinary tumor board.
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Chui JN, Papachristos AJ, Mechera R, Sidhu SB, Sywak MS, Lee JC, Gundara J, Lai C, Glover AR. Unexpected deaths after endocrine surgery: learning from rare events using a national audit of surgical mortality. Br J Surg 2022; 109:1164-1171. [PMID: 35927948 PMCID: PMC10364700 DOI: 10.1093/bjs/znac276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/07/2022] [Accepted: 07/16/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND The mortality rate is low in endocrine surgery, making it a difficult outcome to use for quality improvement in individual units. Lessons from population data sets are of value in improving outcomes. Data from the Australian and New Zealand Audit of Surgical Mortality (ANZASM) were used here to understand and elucidate potential systems issues that may contribute to preventable deaths. METHODS ANZASM data relating to 30-day mortality after thyroidectomy, parathyroidectomy, and adrenalectomy from 2009 to 2020 were reviewed. Mortality rates were calculated using billing data. Thematic analysis of independent assessor reports was conducted to produce a coding framework. RESULTS A total of 67 deaths were reported, with an estimated mortality rate of 0.03-0.07 per cent (38 for thyroidectomy (0.03-0.06 per cent), 16 for parathyroidectomy (0.03-0.06 per cent), 13 for adrenalectomy (0.15-0.33 per cent)). Twenty-seven deaths (40 per cent) were precipitated by clinically significant adverse events, and 18 (27 per cent) were judged to be preventable by independent ANZASM assessors. Recurrent themes included inadequate preoperative assessment, lack of anticipation of intraoperative pitfalls, and failure to recognize and effectively address postoperative complications. Several novel themes were reiterated, such as occult ischaemic heart disease associated with death after parathyroid surgery, unexpected intraoperative difficulties from adrenal metastasis, and complications due to anticoagulation therapy after thyroid surgery. CONCLUSION This study represents a large-scale national report of deaths after endocrine surgery and provides insights into these rare events. Although the overall mortality rate is low, 27 per cent of deaths involved systems issues that were preventable following independent peer review.
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Affiliation(s)
| | | | - Robert Mechera
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Stan B Sidhu
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mark S Sywak
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - James C Lee
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Justin Gundara
- Department of Surgery, Redland Hospital, Metro South and Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Surgery, Logan Hospital, Metro South and School of Medicine and Dentistry, Griffith University, Logan, Australia
| | - Christine Lai
- Division of Surgery, University of Adelaide, Adelaide, South Australia, Australia
- Department of Surgery, Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Anthony R Glover
- Correspondence to: Anthony R. Glover, Royal North Shore Hospital Level 3, Endocrine and Oncology, ASB, St Leonards, New South Wales, 2065, Australia (e-mail: )
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Chee YJ, Teo CHY, Au RTM, Kon YC. Subclinical phaeochromocytoma: a diagnostic and management challenge. BMJ Case Rep 2022; 15:e248571. [PMID: 35428667 PMCID: PMC9014025 DOI: 10.1136/bcr-2021-248571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/04/2022] Open
Abstract
There is a paradigm shift in the detection of phaeochromocytomas with more being identified as adrenal 'incidentalomas'. While majority of these individuals are asymptomatic, they are nevertheless at risk of subtle cardiovascular dysfunction and phaeochromocytoma crises. Therefore, early resection of phaeochromocytomas, even if subclinical, is recommended. However, the perioperative management can be challenging as the normotension can limit the initiation and titration of alpha-blockade. We present a man in his 60s with a subclinical phaeochromocytoma, discuss the evaluation of an incidentally discovered adrenal nodule, as well as the practical considerations in the perioperative management.
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Affiliation(s)
- Ying Jie Chee
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
| | | | | | - Yin Chian Kon
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
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Barat M, Cottereau AS, Gaujoux S, Tenenbaum F, Sibony M, Bertherat J, Libé R, Gaillard M, Jouinot A, Assié G, Hoeffel C, Soyer P, Dohan A. Adrenal Mass Characterization in the Era of Quantitative Imaging: State of the Art. Cancers (Basel) 2022; 14:cancers14030569. [PMID: 35158836 PMCID: PMC8833697 DOI: 10.3390/cancers14030569] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 12/30/2022] Open
Abstract
Simple Summary Non-invasive characterization of adrenal lesions requires a rigorous approach. Although CT is the cornerstone of adrenal lesion characterization, a multimodality multiparametric imaging approach helps improve confidence in adrenal lesion characterization. Abstract Detection and characterization of adrenal lesions have evolved during the past two decades. Although the role of imaging in adrenal lesions associated with hormonal secretion is usually straightforward, characterization of non-functioning adrenal lesions may be challenging to confidently identify those that need to be resected. Although many adrenal lesions can be readily diagnosed when they display typical imaging features, the diagnosis may be challenging for atypical lesions. Computed tomography (CT) remains the cornerstone of adrenal imaging, but other morphological or functional modalities can be used in combination to reach a diagnosis and avoid useless biopsy or surgery. Early- and delayed-phase contrast-enhanced CT images are essential for diagnosing lipid-poor adenoma. Ongoing studies are evaluating the capabilities of dual-energy CT to provide valid virtual non-contrast attenuation and iodine density measurements from contrast-enhanced examinations. Adrenal lesions with attenuation values between 10 and 30 Hounsfield units (HU) on unenhanced CT can be characterized by MRI when iodinated contrast material injection cannot be performed. 18F-FDG PET/CT helps differentiate between atypical benign and malignant adrenal lesions, with the adrenal-to-liver maximum standardized uptake value ratio being the most discriminative variable. Recent studies evaluating the capabilities of radiomics and artificial intelligence have shown encouraging results.
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Affiliation(s)
- Maxime Barat
- Department of Radiology, Cochin Teaching Hospital, AP-HP, Université de Paris, 75014 Paris, France; (M.B.); (P.S.)
- Faculté de Médecine, Université de Paris, 75006 Paris, France; (A.-S.C.); (S.G.); (M.S.); (J.B.); (R.L.); (M.G.); (A.J.); (G.A.)
| | - Anne-Ségolène Cottereau
- Faculté de Médecine, Université de Paris, 75006 Paris, France; (A.-S.C.); (S.G.); (M.S.); (J.B.); (R.L.); (M.G.); (A.J.); (G.A.)
- Department of Nuclear Medicine, Cochin Hospital, AP-HP, 75014 Paris, France;
| | - Sébastien Gaujoux
- Faculté de Médecine, Université de Paris, 75006 Paris, France; (A.-S.C.); (S.G.); (M.S.); (J.B.); (R.L.); (M.G.); (A.J.); (G.A.)
- Department of Pancreatic and Endocrine Surgery, Pitié-Salpetrière Hospital, AP-HP, 75013 Paris, France
| | - Florence Tenenbaum
- Department of Nuclear Medicine, Cochin Hospital, AP-HP, 75014 Paris, France;
| | - Mathilde Sibony
- Faculté de Médecine, Université de Paris, 75006 Paris, France; (A.-S.C.); (S.G.); (M.S.); (J.B.); (R.L.); (M.G.); (A.J.); (G.A.)
- Department of Pathology, Cochin Hospital, AP-HP, 75014 Paris, France
| | - Jérôme Bertherat
- Faculté de Médecine, Université de Paris, 75006 Paris, France; (A.-S.C.); (S.G.); (M.S.); (J.B.); (R.L.); (M.G.); (A.J.); (G.A.)
- Department of Endocrinology, Cochin Hospital, AP-HP, 75014 Paris, France
| | - Rossella Libé
- Faculté de Médecine, Université de Paris, 75006 Paris, France; (A.-S.C.); (S.G.); (M.S.); (J.B.); (R.L.); (M.G.); (A.J.); (G.A.)
- Department of Endocrinology, Cochin Hospital, AP-HP, 75014 Paris, France
| | - Martin Gaillard
- Faculté de Médecine, Université de Paris, 75006 Paris, France; (A.-S.C.); (S.G.); (M.S.); (J.B.); (R.L.); (M.G.); (A.J.); (G.A.)
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Cochin Hospital, AP-HP, 75014 Paris, France
| | - Anne Jouinot
- Faculté de Médecine, Université de Paris, 75006 Paris, France; (A.-S.C.); (S.G.); (M.S.); (J.B.); (R.L.); (M.G.); (A.J.); (G.A.)
- Department of Endocrinology, Cochin Hospital, AP-HP, 75014 Paris, France
| | - Guillaume Assié
- Faculté de Médecine, Université de Paris, 75006 Paris, France; (A.-S.C.); (S.G.); (M.S.); (J.B.); (R.L.); (M.G.); (A.J.); (G.A.)
- Department of Endocrinology, Cochin Hospital, AP-HP, 75014 Paris, France
| | | | - Philippe Soyer
- Department of Radiology, Cochin Teaching Hospital, AP-HP, Université de Paris, 75014 Paris, France; (M.B.); (P.S.)
- Faculté de Médecine, Université de Paris, 75006 Paris, France; (A.-S.C.); (S.G.); (M.S.); (J.B.); (R.L.); (M.G.); (A.J.); (G.A.)
| | - Anthony Dohan
- Department of Radiology, Cochin Teaching Hospital, AP-HP, Université de Paris, 75014 Paris, France; (M.B.); (P.S.)
- Faculté de Médecine, Université de Paris, 75006 Paris, France; (A.-S.C.); (S.G.); (M.S.); (J.B.); (R.L.); (M.G.); (A.J.); (G.A.)
- Correspondence:
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6
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Hsiao R, Chow A, Kluijfhout WP, Bongers PJ, Verzijl R, Metser U, Veit-Haibach P, Pasternak JD. The clinical consequences of functional adrenal uptake in the absence of cross-sectional mass on FDG-PET/CT in oncology patients. Langenbecks Arch Surg 2022; 407:1677-1684. [PMID: 34993609 DOI: 10.1007/s00423-021-02379-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Oncology patients undergoing positron emission tomography/computed tomography (PET/CT) occasionally show discrete adrenal [18F]-fluorodeoxyglucose (FDG) uptake without an associated nodule on CT, leaving the clinician uncertain about the need to proceed with biopsy or surgical referral. This study aimed to identify the prevalence of this radiological finding and to evaluate the effectiveness of FDG uptake values in risk stratification for adrenal metastasis. METHODS From 2014 to 2015, oncology patients who underwent FDG-PET/CT and demonstrated elevated FDG uptake in the adrenal gland without discrete nodularity on cross-sectional imaging were included in a retrospective cohort analysis. Clinical records and FDG-PET/CT scans were reviewed for clinicopathological data, follow-up data, SUVmax (highest SUV of either adrenal gland), and SUVratio (SUVmax/background liver uptake). A receiver operating characteristic analysis was conducted to evaluate the associations between SUV values and the progression to adrenal metastasis. RESULTS Of 3040 oncology patients who underwent FDG-PET/CT scans, 92 (3.0%) showed elevated adrenal uptake without associated mass. From the final study cohort of 66 patients with comprehensive follow-up data, 5 patients (7.6%) developed evidence of adrenal metastasis. At SUVmax < 3.25 (AUC = 0.757) and SUVratio < 1.27 (AUC = 0.907), 34.8% and 60.6% of patients could be excluded with 100% negative predictive value, respectively. CONCLUSIONS Thresholds of SUVmax and SUVratio identified a significant proportion of patients who did not develop adrenal metastasis. In oncology patients who demonstrate increased adrenal FDG uptake without a discrete lesion on FDG-PET/CT, quantitative uptake values may be useful in selecting those not at risk of developing adrenal metastatic disease.
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Affiliation(s)
- Ralph Hsiao
- Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Alicia Chow
- Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | | | - Pim J Bongers
- Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Raoul Verzijl
- Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Ur Metser
- Joint Department of Medical Imaging, University Health Network, Ontario, Toronto, Canada
| | - Patrick Veit-Haibach
- Joint Department of Medical Imaging, University Health Network, Ontario, Toronto, Canada
| | - Jesse D Pasternak
- Department of Surgery, University Health Network, Toronto, Ontario, Canada.
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7
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Metman MJH, Viëtor CL, Seinen AJ, Berends AMA, Hemmer PHJ, Kerstens MN, Feelders RA, Franssen GJH, van Ginhoven TM, Kruijff S. Outcomes after Surgical Treatment of Metastatic Disease in the Adrenal Gland; Valuable for the Patient? Cancers (Basel) 2021; 14:cancers14010156. [PMID: 35008320 PMCID: PMC8750225 DOI: 10.3390/cancers14010156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/09/2021] [Accepted: 12/25/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Adrenal glands are common dissemination sites for metastases of various solid tumors. The rapid development of new treatment strategies, such as targeted therapy and immunotherapy for different cancer types, has led to increased metastatic adrenalectomies. Therefore, clear communication between oncologists and adrenal gland specialists has become increasingly important to outweigh surgical risks versus oncological advantages of adrenalectomies in these patients. This study assesses trends in diagnosis, type of surgery, and short-term and long-term surgical outcomes of patients who underwent metastatic adrenalectomy. We included a total of 95 patients with an adrenal metastasis of non-adrenal primary tumors, most often colorectal or lung cancer, who underwent (minimal invasive) adrenalectomy. 37.9% of the patients experienced one or more complications after adrenalectomy. Within our patient cohort, an increased demand for metastatic adrenalectomy was observed over the past years, which might be associated with the rise of targeted- and immunotherapy. Our data aims to assist multidisciplinary teams with weighing the pros and cons of resection of the metastasized adrenal gland of cancer patients. Abstract The adrenal glands are common dissemination sites for metastasis of various solid tumors. Surgical treatment is often recommended because targeted therapies and immunotherapy are frequently ineffective for adrenal metastasis. We report the experience with short-term and long-term surgical outcomes of patients undergoing surgery for adrenal metastasis in two hospitals. A retrospective, multicenter study was performed to analyze patient characteristics, tumor-related data, perioperative outcomes, and oncological outcomes. Postoperative complications that occurred within 30 days were scored according to the Clavien Dindo classification. Metastatic adrenalectomy was performed in 95 patients. We observed an increase from an average of 3 metastatic adrenalectomies per year between 2001–2005 to 10 between 2015–2019. The most frequent underlying malignancies were colorectal and lung cancer. In 55.8%, minimal invasive adrenalectomy was performed, including six conversions to open surgery. A total of 37.9% of patients had postoperative complications, of which ileus or gastroparesis, wound problems, pneumonia, and heart arrhythmias were the most occurring complications. Improved cancer care has led to an increased demand for metastatic adrenalectomy over the past years. Complication rates of 37.9% are significant and cannot be neglected. Therefore, multidisciplinary teams should weigh the decision to perform metastatic adrenalectomy for each patient individually, taking into account the drawbacks of the described morbidity versus the potential benefits.
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Affiliation(s)
- Madelon J. H. Metman
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (M.J.H.M.); (A.J.S.); (P.H.J.H.)
| | - Charlotte L. Viëtor
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (C.L.V.); (G.J.H.F.); (T.M.v.G.)
| | - Auke J. Seinen
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (M.J.H.M.); (A.J.S.); (P.H.J.H.)
| | - Annika M. A. Berends
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (A.M.A.B.); (M.N.K.)
| | - Patrick H. J. Hemmer
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (M.J.H.M.); (A.J.S.); (P.H.J.H.)
| | - Michiel N. Kerstens
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (A.M.A.B.); (M.N.K.)
| | - Richard A. Feelders
- Department of Endocrinology, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands;
| | - Gaston J. H. Franssen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (C.L.V.); (G.J.H.F.); (T.M.v.G.)
| | - Tessa M. van Ginhoven
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (C.L.V.); (G.J.H.F.); (T.M.v.G.)
| | - Schelto Kruijff
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (M.J.H.M.); (A.J.S.); (P.H.J.H.)
- Correspondence:
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Daprano WT, Shroff S, Neychev V. Incidental Adrenal Mass in a Patient With Surgically Treated Lung Adenocarcinoma. Cureus 2021; 13:e19938. [PMID: 34984114 PMCID: PMC8714050 DOI: 10.7759/cureus.19938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/27/2021] [Indexed: 11/23/2022] Open
Abstract
Adrenal metastases are not uncommon in patients with widespread metastatic lung cancer. Isolated metachronous adrenal metastases in cases of surgically treated lung cancer without long-term evidence of disease are rare and may pose a diagnostic and treatment dilemma. The current literature suggests that in such cases, adrenalectomy provides better median and overall survival rates. This case presents an incidentally discovered isolated adrenal mass in a patient with a past medical history of lung adenocarcinoma that was surgically removed three years before metastasis discovery. The patient successfully underwent adrenalectomy and was disease-free with no apparent complications at her three-month follow-up visit. The case highlights the importance of long-term radiographic surveillance after surgical resection of lung adenocarcinoma for the prompt diagnosis and timely treatment of metachronous metastases.
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Affiliation(s)
- William T Daprano
- Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Seema Shroff
- Department of Pathology, AdventHealth Orlando, Orlando, USA
| | - Vladimir Neychev
- Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando, USA
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9
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Staubitz JI, Clerici T, Riss P, Watzka F, Bergenfelz A, Bareck E, Fendrich V, Goldmann A, Grafen F, Heintz A, Kaderli RM, Karakas E, Kern B, Matter M, Mogl M, Nebiker CA, Niederle B, Obermeier J, Ringger A, Schmid R, Triponez F, Trupka A, Wicke C, Musholt TJ. [EUROCRINE®: adrenal surgery 2015-2019- surprising initial results]. Chirurg 2021; 92:448-463. [PMID: 32945919 PMCID: PMC8081706 DOI: 10.1007/s00104-020-01277-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hintergrund Seit 2015 erfolgt in Europa mithilfe des EUROCRINE®-Registers eine systematische Dokumentation endokrin-chirurgischer Operationen. Ziel dieser ersten Auswertung war eine Darstellung der Versorgungsrealität für Nebenniereneingriffe in einem homogenen Versorgungsumfeld, entsprechend des deutschsprachigen Raums – bzw. des Präsenzgebiets der Chirurgischen Arbeitsgemeinschaft Endokrinologie (CAEK) der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) – einschließlich einer Analyse der Adhärenz zu geltenden Therapieempfehlungen. Methodik Es erfolgte eine deskriptive Analyse der präoperativen Diagnostik, der angewandten Operationstechniken sowie der zugrunde liegenden histologischen Entitäten der zwischen den Jahren 2015 und 2019 über EUROCRINE® in Deutschland, Österreich und der Schweiz dokumentierten Nebennierenoperationen. Ergebnisse In den insgesamt 21 teilnehmenden Kliniken des deutschsprachigen EUROCRINE®-Gebiets wurden 658 Operationen an Nebennieren durchgeführt. In 90 % erfolgten unilaterale, in 3 % bilaterale Adrenalektomien und in 7 % andere Resektionsverfahren. Die in 41 % der Operationen dokumentierte histologische Hauptdiagnose war das adrenokortikale Adenom. In 15 % lagen maligne Befunde zugrunde (einschließlich 6 % Nebennierenrindenkarzinome (ACC) und 8 % Nebennierenmetastasen). 23 % der Operationen erfolgten bei Phäochromozytomen. Diese wurden zu 82 % minimal-invasiv operiert, Nebennierenrindenkarzinome lediglich zu 28 % und Nebennierenmetastasen zu 66 %. Schlussfolgerung Überraschenderweise wurden nach Nebennierenadenomen und Phäochromozytomen an dritthäufigster Stelle Nebennierenmetastasen unterschiedlicher Primärtumoren reseziert. 28 % der ACC waren für minimal-invasive Techniken vorgesehen, wobei 20 % dieser Fälle eine Konversion zur offenen Operation erforderten. Die aktuelle Analyse deckte Diskrepanzen zwischen Versorgungsrealität und Leitlinienempfehlungen auf, aus denen sich zahlreiche Fragestellungen ergeben, welche nun in ein überarbeitetes EUROCRINE®-Modul zur Dokumentation von Nebennierenoperationen einfließen werden.
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Affiliation(s)
- J I Staubitz
- Sektion Endokrine Chirurgie der Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, Mainz, 55131, Deutschland
| | - T Clerici
- Kantonsspital St. Gallen, St. Gallen, Schweiz
| | - P Riss
- Universitätsklinik für Chirurgie, Medizinische Universität Wien, Wien, Österreich
| | - F Watzka
- Sektion Endokrine Chirurgie der Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, Mainz, 55131, Deutschland
| | | | - E Bareck
- Abteilung für Chirurgie, KRAGES Burgenländische Krankenanstalten-Ges.m.b.H., Oberpullendorf, Österreich
| | - V Fendrich
- Klinik für Endokrine Chirurgie, Schön Klinik Hamburg Eilbek, Hamburg, Deutschland
| | - A Goldmann
- Viszeral- und Thoraxchirurgie, Kantonsspital Winterthur, Winterthur, Schweiz
| | - F Grafen
- Chirurgische Klinik, Spital Limmattal, Schlieren, Schweiz
| | - A Heintz
- Allgemein- und Viszeralchirurgie, Katholisches Klinikum Mainz, Mainz, Deutschland
| | - R M Kaderli
- Viszerale Chirurgie, Universitätsspital Bern, Bern, Schweiz
| | - E Karakas
- Klinik für Allgemein‑, Visceral- und Endokrine Chirurgie, Krankenhaus Maria Hilf Krefeld, Krefeld, Deutschland
| | - B Kern
- Viszeralchirurgie, St. Claraspital Basel, Basel, Schweiz
| | - M Matter
- Chirurgie Viscérale, Centre Hospitalier Universitaire Vaudois, Lausanne, Schweiz
| | - M Mogl
- Chirurgische Klinik, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - C A Nebiker
- Viszeralchirurgie, Kantonsspital Aarau, Aarau, Schweiz
| | - B Niederle
- Abteilung für Chirurgie, Franziskus Spital Wien, Wien, Österreich
| | - J Obermeier
- Klinik für Chirurgie, Klinikum Dortmund gGmbH, Dortmund, Deutschland
| | - A Ringger
- Chirurgie, Solothurner Spitäler AG, Solothurn, Schweiz
| | - R Schmid
- Viszeralchirurgie, Spitalzentrum Biel, Biel, Schweiz
| | - F Triponez
- Chirurgie thoracique et endocrinienne, Hôpitaux Universitaires Genève, Genève, Schweiz
| | - A Trupka
- Chirurgische Klinik, Klinikum Starnberg, Starnberg, Deutschland
| | - C Wicke
- Kantonsspital Luzern, Luzern, Schweiz
| | - T J Musholt
- Sektion Endokrine Chirurgie der Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, Mainz, 55131, Deutschland.
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10
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Battistella E, Ferrari S, Pomba L, Toniato A. Adrenal surgery: Review of 35 years experience in a single centre. Surg Oncol 2021; 37:101554. [PMID: 33848760 DOI: 10.1016/j.suronc.2021.101554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/15/2021] [Accepted: 03/26/2021] [Indexed: 12/07/2022]
Abstract
INTRODUCTION The rate of adrenal disease diagnosed is progressively increasing due to the diagnostic tools improvement. We analysed patients that underwent to adrenalectomy in our centre for different adrenal pathologies and we tried to established guidelines for the surgical therapy. METHODS Demographic and clinical data were prospectively entered in a computerized endocrine surgery registry for all patients who underwent surgery for adrenal lesions at our institution over a 35-year period and statistical analyses was performed. RESULTS Between 1986 and 2020, 502 patients underwent adrenalectomy: open adrenalectomy (OA) was performed in 104 patients (28,6%), laparoscopic adrenalectomy (LA) in 398 patients (71,4%). The rate of conversion to OA was 5,9% (21 patients). The mean operating time in laparoscopic approach was 84.3 min (range 40-180) while in open approach was 121.9 min (40-210). The average length of stay (LOS) for LA was 3.6 days, while for OA was 7.4 days. The time to return to normal activity for LA was 21 days while for OA was 37 days. CONCLUSIONS The progressive increase in the number of adrenalectomies performed is due more to a better understanding of adrenal disease than to the availability of minimally invasive techniques. The choice of a laparoscopic approach should depend on the surgeon's experience, regardless the dimension of the lesion. Considering our long experience, we suggest OA for lesion of more of 6 cm, for malignant lesion with a diameter higher than 3 cm or with a pre-operatory evidence of invasion of the surrounding tissue.
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Affiliation(s)
- Enrico Battistella
- Department of Surgery, Endocrine Surgery Unit, Veneto Institute of Oncology, IOV-IRCSS, Padua, Italy.
| | - Stefania Ferrari
- Department of Surgery, Endocrine Surgery Unit, Veneto Institute of Oncology, IOV-IRCSS, Padua, Italy
| | - Luca Pomba
- Department of Surgery, Endocrine Surgery Unit, Veneto Institute of Oncology, IOV-IRCSS, Padua, Italy
| | - Antonio Toniato
- Department of Surgery, Endocrine Surgery Unit, Veneto Institute of Oncology, IOV-IRCSS, Padua, Italy
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11
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Manso J, Sharifi-Rad J, Zam W, Tsouh Fokou PV, Martorell M, Pezzani R. Plant Natural Compounds in the Treatment of Adrenocortical Tumors. Int J Endocrinol 2021; 2021:5516285. [PMID: 34567112 PMCID: PMC8463247 DOI: 10.1155/2021/5516285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/14/2021] [Accepted: 08/31/2021] [Indexed: 01/08/2023] Open
Abstract
Plant natural products are a plethora of diverse and complex molecules produced by the plant secondary metabolism. Among these, many can reserve beneficial or curative properties when employed to treat human diseases. Even in cancer, they can be successfully used and indeed numerous phytochemicals exert antineoplastic activity. The most common molecules derived from plants and used in the fight against cancer are polyphenols, i.e., quercetin, genistein, resveratrol, curcumin, etc. Despite valuable data especially in preclinical models on such compounds, few of them are currently used in the medical practice. Also, in adrenocortical tumors (ACT), phytochemicals are scarcely or not at all used. This work summarizes the available research on phytochemicals used against ACT and adrenocortical cancer, a very rare disease with poor prognosis and high metastatic potential, and wants to contribute to stimulate preclinical and clinical research to find new therapeutic strategies among the overabundance of biomolecules produced by the plant kingdom.
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Affiliation(s)
- Jacopo Manso
- Endocrinology Unit, Department of Medicine (DIMED), University of Padova, Via Ospedale 105, Padova 35128, Italy
| | - Javad Sharifi-Rad
- Phytochemistry Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Facultad de Medicina, Universidad del Azuay, Cuenca, Ecuador
| | - Wissam Zam
- Analytical and Food Chemistry Department, Faculty of Pharmacy, Tartous University, Tartous, Syria
| | | | - Miquel Martorell
- Department of Nutrition and Dietetics, Faculty of Pharmacy, Centre for Healthy Living, University of Concepción, Concepción 4070386, Chile
- Universidad de Concepción, Unidad de Desarrollo Tecnológico, UDT, Concepción 4070386, Chile
| | - Raffaele Pezzani
- Endocrinology Unit, Department of Medicine (DIMED), University of Padova, Via Ospedale 105, Padova 35128, Italy
- Phytotherapy Lab, Endocrinology Unit, Department of Medicine (DIMED), University of Padova, via Ospedale 105, 35128 Padova, Italy
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12
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Survival After Adrenalectomy for Metastatic Hepatocellular Carcinoma: A 25-year Institutional Experience. World J Surg 2020; 45:1118-1125. [PMID: 33354731 PMCID: PMC7921034 DOI: 10.1007/s00268-020-05909-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2020] [Indexed: 12/30/2022]
Abstract
Background Extrahepatic manifestation of hepatocellular carcinoma (HCC) is rare and primarily affects lung, lymph nodes and bone. Metastases to the adrenal glands are relatively infrequent. This 25-year institutional experience aimed for an analysis of factors influencing survival in patients undergoing surgery for HCC adrenal metastasis. Methods A retrospective analysis of the institutional database of the Clinic for General-, Visceral- and Transplantation Surgery of the University Medical Center Mainz, Germany, was performed. Patients who underwent surgery for HCC adrenal metastases from January 1995 to June 2020 were included. Pre-, peri- and postoperative factors with potential influence on survival were assessed. Results In 16 patients (14 males, two females), one bilateral and 15 unilateral adrenalectomies were performed (13 metachronous, three synchronous). Thirteen operations were carried out via laparotomy, and three adrenalectomies were minimally invasive (two laparoscopic, one retroperitoneoscopic). Median overall survival (after HCC diagnosis) was 35 months, range: 5–198. Median post-resection survival (after adrenalectomy) was 15 months, range: 0–75. Overall survival was longer in patients with the primary HCC treatment being liver transplantation (median 66 months) or liver resection (median 51 months), compared to only palliative intended treatment of the primary with chemotherapy (median 35 months) or local ablation (median 23 months). Conclusions Surgery is a feasible treatment option for patients with adrenal metastases originating from HCC. In patients who underwent adrenalectomy for HCC adrenal metastasis, overall survival was superior, if primary HCC treatment was potentially curative (liver transplantation or resection).
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13
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Mazzaglia PJ, Varghese J, Habra MA. Evaluation and management of adrenal neoplasms: endocrinologist and endocrine surgeon perspectives. Abdom Radiol (NY) 2020; 45:1001-1010. [PMID: 32189021 DOI: 10.1007/s00261-020-02464-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The evaluation and management of adrenal disease is a complex endeavor that relies on an expert knowledge of human physiology and anatomy. Careful and proper patient assessment mandates a balanced approach which marries the disciplines of endocrinology, surgery, and radiology. Any of these three specialties may be on the front line in performing the initial workup when an adrenal neoplasm is discovered. With an ever-increasing volume of cross-sectional imaging, be it CT, MRI, or PET, large numbers of adrenal incidentalomas are being discovered. A close collaboration amongst specialties should strive to streamline the initial evaluation and minimize unnecessary testing and treatment.
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14
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Couñago F, Luna J, Guerrero LL, Vaquero B, Guillén-Sacoto MC, González-Merino T, Taboada B, Díaz V, Rubio-Viqueira B, Díaz-Gavela AA, Marcos FJ, del Cerro E. Management of oligometastatic non-small cell lung cancer patients: Current controversies and future directions. World J Clin Oncol 2019; 10:318-339. [PMID: 31799148 PMCID: PMC6885452 DOI: 10.5306/wjco.v10.i10.318] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/30/2019] [Accepted: 09/13/2019] [Indexed: 02/06/2023] Open
Abstract
Oligometastatic non-small cell lung cancer (NSCLC) describes an intermediate stage of NSCLC between localized and widely-disseminated disease. This stage of NSCLC is characterized by a limited number of metastases and a more indolent tumor biology. Currently, the management of oligometastatic NSCLC involves radical treatment (radiotherapy or surgery) that targets the metastatic lesions and the primary tumor to achieve disease control. This approach offers the potential to achieve prolonged survival in patients who, in the past, would have only received palliative measures. The optimal therapeutic strategies for the different scenarios of oligometastatic disease (intracranial vs extracranial disease, synchronous vs metachronous) remain undefined. Given the lack of head-to-head studies comparing radiotherapy to surgery in these patients, the decision to apply surgery or radiotherapy (with or without systemic treatment) must be based on prognostic factors that allow us to classify patients. This classification will allow us to select the most appropriate therapeutic strategy on an individualized basis. In the future, the molecular or microRNA profiles will likely improve the treatment selection process. The objective of the present article is to review the most relevant scientific evidence on the management of patients with oligometastatic NSCLC, focusing on the role of radiotherapy and surgery. We also discuss areas of controversy and future directions.
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Affiliation(s)
- Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Madrid 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
- Clinical Department, Faculty of Biomedicine, Universidad Europea, Madrid 28223, Spain
| | - Javier Luna
- Department of Radiation Oncology, Hospital Fundación Jiménez Díaz, Madrid 28040, Spain
| | | | - Blanca Vaquero
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
| | | | | | - Begoña Taboada
- Department of Radiation Oncology, Complexo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela 15706, Spain
| | - Verónica Díaz
- Department of Radiation Oncology, Hospital Universitario Puerta del Mar, Cádiz 11009, Spain
| | - Belén Rubio-Viqueira
- Department of Medical Oncology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Madrid 28223, Spain
| | - Ana Aurora Díaz-Gavela
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Madrid 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
- Clinical Department, Faculty of Biomedicine, Universidad Europea, Madrid 28223, Spain
| | - Francisco José Marcos
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Madrid 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
- Clinical Department, Faculty of Biomedicine, Universidad Europea, Madrid 28223, Spain
| | - Elia del Cerro
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Madrid 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
- Clinical Department, Faculty of Biomedicine, Universidad Europea, Madrid 28223, Spain
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15
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Goto T, Inoue T, Kobayashi T, Yamasaki T, Ishitoya S, Segawa T, Ito N, Shichiri Y, Okumura K, Okuno H, Kawakita M, Kanaoka T, Terada N, Mukai S, Sugi M, Kinoshita H, Kamoto T, Matsuda T, Ogawa O. Feasibility of laparoscopic adrenalectomy for metastatic adrenal tumors in selected patients: a retrospective multicenter study of Japanese populations. Int J Clin Oncol 2019; 25:126-134. [PMID: 31471786 DOI: 10.1007/s10147-019-01533-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/20/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Because of the small numbers of cases in single centers, the indications for and survival benefits of adrenalectomy for adrenal metastasis remain unclear. We evaluated the outcomes of laparoscopic adrenalectomy for patients with adrenal metastasis. METHODS We retrospectively analyzed the records of 67 patients who underwent laparoscopic adrenalectomy for metastatic disease from 2003 to 2017 at 11 hospitals. Associations of clinical, surgical, and pathologic features with overall survival (OS) and positive surgical margins were evaluated using univariate and multivariate Cox regression analyses and univariate logistic regression analysis. RESULTS Lung cancer (30%) and renal cell carcinoma (30%) were the most common primary tumor types. Intraoperative complications were observed in seven patients (10%) and postoperative complications in seven (10%). The surgical margin was positive in 10 patients (15%). The median OS was 3.8 years. Univariate analysis showed that the tumor size, episodes of extra-adrenal metastasis before adrenalectomy, extra-adrenal metastasis at the time of adrenalectomy, and positive surgical margins were significantly associated with shorter OS (p = 0.022, p = 0.005, p < 0.001, and p = 0.022, respectively). Multivariate analysis showed that extra-adrenal metastasis at the time of adrenalectomy and positive surgical margins remained statistically significant (p = 0.022 and p = 0.049, respectively). In the univariate analysis, the tumor size was significantly associated with positive surgical margins (p = 0.039). CONCLUSIONS Laparoscopic adrenalectomy for adrenal metastasis can be safely performed in selected patients, and patients with isolated adrenal metastasis and negative surgical margins seem to have more favorable outcomes.
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Affiliation(s)
- Takayuki Goto
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Takahiro Inoue
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Takashi Kobayashi
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Toshinari Yamasaki
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Satoshi Ishitoya
- Department of Urology, Japanese Red Cross Otsu Hospital, Otsu, Shiga, Japan
| | | | - Noriyuki Ito
- Department of Urology, Kobe City Nishi-Kobe Medical Center, Kobe, Hyogo, Japan
| | | | | | - Hiroshi Okuno
- Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Mutsushi Kawakita
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Toshio Kanaoka
- Department of Urology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Naoki Terada
- Department of Urology, University of Miyazaki Hospital, Miyazaki, Japan
| | - Shoichiro Mukai
- Department of Urology, University of Miyazaki Hospital, Miyazaki, Japan
| | - Motohiko Sugi
- Department of Urology, Kansai Medical University Hospital, Osaka, Japan
| | | | - Toshiyuki Kamoto
- Department of Urology, University of Miyazaki Hospital, Miyazaki, Japan
| | - Tadashi Matsuda
- Department of Urology, Kansai Medical University Hospital, Osaka, Japan
| | - Osamu Ogawa
- Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
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16
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Da Dalt G, Friziero A, Grego A, Serafini S, Fassina A, Blandamura S, Sperti C. Adrenal metastasis from endometrial cancer: A case report. World J Clin Cases 2019; 7:1844-1849. [PMID: 31417930 PMCID: PMC6692260 DOI: 10.12998/wjcc.v7.i14.1844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/30/2019] [Accepted: 05/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Metastases to adrenal glands originate principally from lung, breast, or gastrointestinal cancers, followed by malignant melanoma and thyroid neoplasms. We present an unusual case of uterine cancer metastasizing to the adrenal glands with a review of the English literature on the management of this rare disease. CASE SUMMARY A 53-year-old Caucasian woman with a history of endometrial cancer (grade 2; International Federation of Gynecology and Obstetrics III A) was hospitalized in November 2017 for a left adrenal mass found on a follow-up computed tomography scan 3 years after her gynecological surgery. Laboratory test results were normal. A laparoscopic left adrenalectomy was performed. The postoperative course was uneventful, and no chemotherapy was administered. The pathological report confirmed an adrenal endometrioid metastasis. At 36 mo of follow-up, the patient is alive and well, with no evidence of recurrent disease. A literature review identified only 11 previously-published cases of adrenal metastases from uterine cancer. CONCLUSION Adrenal metastasis from uterine cancer is very rare. Laparoscopic adrenalectomy may be an effective treatment in selected cases of localized adrenal metastasis.
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Affiliation(s)
- Gianfranco Da Dalt
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Padua 35128, Italy
| | - Alberto Friziero
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Padua 35128, Italy
| | - Andrea Grego
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Padua 35128, Italy
| | - Simone Serafini
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Padua 35128, Italy
| | - Ambrogio Fassina
- Department of Medicine, Surgical Pathology and Cytopathology, University of Padua, Padua 35128, Italy
| | - Stella Blandamura
- Department of Medicine, Surgical Pathology and Cytopathology, University of Padua, Padua 35128, Italy
| | - Cosimo Sperti
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Padua 35128, Italy
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17
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Lorenz K, Langer P, Niederle B, Alesina P, Holzer K, Nies C, Musholt T, Goretzki PE, Rayes N, Quinkler M, Waldmann J, Simon D, Trupka A, Ladurner R, Hallfeldt K, Zielke A, Saeger D, Pöppel T, Kukuk G, Hötker A, Schabram P, Schopf S, Dotzenrath C, Riss P, Steinmüller T, Kopp I, Vorländer C, Walz MK, Bartsch DK. Surgical therapy of adrenal tumors: guidelines from the German Association of Endocrine Surgeons (CAEK). Langenbecks Arch Surg 2019; 404:385-401. [PMID: 30937523 DOI: 10.1007/s00423-019-01768-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/19/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS Previous guidelines addressing surgery of adrenal tumors required actualization in adaption of developments in the area. The present guideline aims to provide practical and qualified recommendations on an evidence-based level reviewing the prevalent literature for the surgical therapy of adrenal tumors referring to patients of all age groups in operative medicine who require adrenal surgery. It primarily addresses general and visceral surgeons but offers information for all medical doctors related to conservative, ambulatory or inpatient care, rehabilitation, and general practice as well as pediatrics. It extends to interested patients to improve the knowledge and participation in the decision-making process regarding indications and methods of management of adrenal tumors. Furthermore, it provides effective medical options for the surgical treatment of adrenal lesions and balances positive and negative effects. Specific clinical questions addressed refer to indication, diagnostic procedures, effective therapeutic alternatives to surgery, type and extent of surgery, and postoperative management and follow-up regime. METHODS A PubMed research using specific key words identified literature to be considered and was evaluated for evidence previous to a formal Delphi decision process that finalized consented recommendations in a multidisciplinary setting. RESULTS Overall, 12 general and 52 specific recommendations regarding surgery for adrenal tumors were generated and complementary comments provided. CONCLUSION Effective and balanced medical options for the surgical treatment of adrenal tumors are provided on evidence-base. Specific clinical questions regarding indication, diagnostic procedures, alternatives to and type as well as extent of surgery for adrenal tumors including postoperative management are addressed.
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Affiliation(s)
- K Lorenz
- Universitätsklinikum Halle, Halle/Saale, Germany.
| | | | - B Niederle
- Ordination Siebenbrunnenstrasse, Wien, Austria
| | - P Alesina
- Kliniken Essen-Mitte, Essen, Germany
| | - K Holzer
- Universitätsklinikum Marburg, Marburg, Germany
| | - Ch Nies
- Marienhospital Osnabrück, Osnabrück, Germany
| | - Th Musholt
- Universitatsklinikum Mainz, Mainz, Germany
| | - P E Goretzki
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | - N Rayes
- Universitätsklinikum Leipzig, Leipzig, Germany
| | - M Quinkler
- Endokrinologiepraxis Berlin, Berlin, Germany
| | - J Waldmann
- MIVENDO Klinik Hamburg, Hamburg, Germany
| | - D Simon
- Evangelisches Krankenhaus BETHESDA Duisburg, Duisburg, Germany
| | - A Trupka
- Klinikum Starnberg, Klinikum Starnberg, Germany
| | - R Ladurner
- Ludwig-Maximilians-Universität München, München, Germany
| | - K Hallfeldt
- Ludwig-Maximilians-Universität München, München, Germany
| | - A Zielke
- Diakonie-Klinikum Stuttgart, Stuttgart, Germany
| | - D Saeger
- Universitätsklinikum Hamburg, Hamburg, Germany
| | - Th Pöppel
- Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - G Kukuk
- Universitätsklinikum Bonn, Bonn, Germany
| | - A Hötker
- Universitätsklinikum Zürich, Zürich, Switzerland
| | - P Schabram
- RAE Ratacjzak und Partner, Sindelfingen, Germany
| | - S Schopf
- Krankenhaus Agatharied, Hausham, Germany
| | - C Dotzenrath
- HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - P Riss
- Medizinische Universität Wien, Wien, Austria
| | - Th Steinmüller
- Deutsches Rotes Kreuz Krankenhaus Berlin, Berlin, Germany
| | - I Kopp
- AWMF, Frankfurt am Main, Germany
| | - C Vorländer
- Bürgerhospital Frankfurt, Frankfurt am Main, Germany
| | - M K Walz
- Kliniken Essen-Mitte, Essen, Germany
| | - D K Bartsch
- Universitätsklinikum Marburg, Marburg, Germany
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18
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Hatano K, Horii S, Nakai Y, Nakayama M, Kakimoto KI, Nishimura K. The outcomes of adrenalectomy for solitary adrenal metastasis: A 17-year single-center experience. Asia Pac J Clin Oncol 2018; 16:e86-e90. [PMID: 30270570 DOI: 10.1111/ajco.13078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/20/2018] [Indexed: 11/29/2022]
Abstract
AIM We aimed to analyze surgical outcomes of open or laparoscopic adrenalectomy for solitary adrenal metastasis and assess the factors influencing survival. METHODS We retrospectively reviewed our institutional clinicopathological database for cases of adrenalectomy for solitary adrenal metastasis from solid tumors between 2000 and 2017. RESULTS Twenty-five patients underwent open adrenalectomy (n = 11) or laparoscopic adrenalectomy (n = 14). The most common primary site was the lung (n = 7), followed by the kidney (n = 5), liver (n = 3), ovary (n = 2), soft tissue (n = 2), and six other sites. The majority of the patients (n = 19) had metachronous metastasis. The median tumor size was 3.1 cm (1-9 cm). With the median follow-up of 32 months (2-144 months), the median progression-free and overall survivals were 14 and 63 months, respectively. Multivariate analysis revealed that synchronous metastasis (hazard ratio [HR] = 7.5) and tumor size ≥ 4 cm (HR = 17.7) were significant prognostic factors for shorter overall survival. There was no significant difference for survival between the laparoscopic and open groups. CONCLUSIONS Adrenalectomy for solitary adrenal metastasis can be applied for selected patients with various types of malignancy. However, synchronous metastasis and tumor size ≥ 4 cm were prognostic factors for shorter overall survival.
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Affiliation(s)
- Koji Hatano
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Sayaka Horii
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Yasutomo Nakai
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Masashi Nakayama
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Ken-Ichi Kakimoto
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuo Nishimura
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
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Yuan H, Liu F, Li X, Guan Y, Wang M. Clinical efficacy of chemoembolization with simultaneous radiofrequency ablation for treatment of adrenal metastases from hepatocellular carcinoma. Cancer Imaging 2018; 18:24. [PMID: 30064514 PMCID: PMC6069544 DOI: 10.1186/s40644-018-0157-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/16/2018] [Indexed: 12/11/2022] Open
Abstract
Background This study investigated the safety and efficacy of transcatheter arterial chemoembolization (TACE) with simultaneous radiofrequency ablation (RFA) as treatment for adrenal metastases (AM) from hepatocellular carcinoma(HCC). Methods The records of 63 patients with AM who were treated at our Hospital between February 2013 and August 2016 were retrospectively reviewed. Patients were divided into a TACE+RFA group (n = 38) and a control group that received TACE alone (n = 25) according to different treatment methods. The success rate, tumor control rate, and safety of these groups were compared, and survival was evaluated using the Kaplan-Meier method. Results All treatments could be completed technically successful in both groups. The tumor control rate at first imaging after 1 months was 92.1% (35/38) in the TACE+RFA group and 76.0% (19/25) in the TACE group(P = 0.041). The assisted local tumor control rate allowing repeated interventions in case of local recurrence was 70.0% (7/10) in the TACE+RFA group and 30.8% (4/13) in the TACE group (P = 0.039). During the follow up period, the TACE+RFA group had better survival than the TACE group at 1 year (92.1% vs. 88.0%), 2 years (73.7% vs. 64.0%), and 3 years (55.3% vs. 44.0%) (P = 0.040). The mean survival time was 26.8 ± 2.0 months (95% CI, 22.8–30.7) in the TACE+RFA group and 17.5 ± 2.2 months (95% CI, 13.1–21.8) in the TACE group. Conclusion TACE+RFA led to better control of local disease progression and longer survival time than TACE alone in the treatment of AM from HCC. Although patients given TACE+RFA had more complications than those given TACE alone, these complications were easily managed.
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Affiliation(s)
- Hongjun Yuan
- Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Fengyong Liu
- Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Xin Li
- Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Yang Guan
- Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Maoqiang Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, People's Republic of China
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Zhou K, Pan J, Yang N, Shi HF, Cao J, Li YM, Zhang HZ, Wang KF, Chen SH. Effectiveness and safety of CT-guided percutaneous radiofrequency ablation of adrenal metastases. Br J Radiol 2018; 91:20170607. [PMID: 29350539 DOI: 10.1259/bjr.20170607] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The imaging-guided percutaneous radiofrequency (RF) ablation of adrenal metastases is a relatively new treatment procedure, compared to the more widespread application of the technique for the treatment of liver and renal cancers. The present study aims to evaluate the safety and efficacy of the CT-guided percutaneous RF ablation of adrenal metastases in a cohort of patients. METHODS 33 patients with 38 adrenal metastases who received percutaneous CT-guided RF ablation between 2012 to 2015 were retrospectively reviewed. The average diameter of the treated adrenal metastases was 3.0 ± 1.6 cm. The treatment outcomes, including presence of residual tumours, technical success rate, recurrence rate, and complications, were evaluated. Patients were followed up for every 3 months to monitor the progression of the disease. RESULTS Postoperative CT images showed the lack of tumour enhancement in 30 tumours (30/38 tumours, technical success rate = 78.9%), and residual disease was found in 7 tumours (7/37 tumours, 18.9%). The rate of residual disease was significantly lower in the group with tumour size <3 cm than the group with tumour size ≥3 cm (p = 0.025). The severe complication rate was 4.3%, and the mild complication rate was 48%, with intraoperative hypertensive crisis as the most frequently observed complication (27.3%). The follow-up data showed that 76.3% of patients had recurrence-free survival in 27.4 months. CONCLUSION The current study demonstrated that radiofrequency ablation is a relatively safe and effective treatment for controlling adrenal metastases, especially for patients with tumour size <3 cm. Advances in knowledge: Surgical resection of the adrenal metastases was advocated as one of the treatment options for patients. The present study showed that radiofrequency ablation is a relatively safe and effective treatment for controlling adrenal metastases.
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Affiliation(s)
- Kang Zhou
- 1 Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences , Beijing , China
| | - Jie Pan
- 1 Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences , Beijing , China
| | - Ning Yang
- 1 Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences , Beijing , China
| | - Hai-Feng Shi
- 1 Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences , Beijing , China
| | - Jian Cao
- 1 Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences , Beijing , China
| | - Yu-Mei Li
- 1 Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences , Beijing , China
| | - Hong-Zhi Zhang
- 1 Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences , Beijing , China
| | - Ke-Fei Wang
- 1 Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences , Beijing , China
| | - Shao-Hui Chen
- 2 Department of Anesthesiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences , Beijing , China
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Chomsky-Higgins K, Seib C, Rochefort H, Gosnell J, Shen WT, Kahn JG, Duh QY, Suh I. Less is more: cost-effectiveness analysis of surveillance strategies for small, nonfunctional, radiographically benign adrenal incidentalomas. Surgery 2017; 163:197-204. [PMID: 29129360 DOI: 10.1016/j.surg.2017.07.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/07/2017] [Accepted: 07/05/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Guidelines for management of small adrenal incidentalomas are mutually inconsistent. No cost-effectiveness analysis has been performed to evaluate rigorously the relative merits of these strategies. METHODS We constructed a decision-analytic model to evaluate surveillance strategies for <4cm, nonfunctional, benign-appearing adrenal incidentalomas. We evaluated 4 surveillance strategies: none, one-time, annual for 2 years, and annual for 5 years. Threshold and sensitivity analyses assessed robustness of the model. Costs were represented in 2016 US dollars and health outcomes in quality-adjusted life-years. RESULTS No surveillance has an expected net cost of $262 and 26.22 quality-adjusted life-years. One-time surveillance costs $158 more and adds 0.2 quality-adjusted life-years for an incremental cost-effectiveness ratio of $778/quality-adjusted life-years. The strategies involving more surveillance were dominated by the no surveillance and one-time surveillance strategies less effective and more expensive. Above a 0.7% prevalence of adrenocortical carcinoma, one-time surveillance was the most effective strategy. The results were robust to all sensitivity analyses of disease prevalence, sensitivity, and specificity of diagnostic assays and imaging as well as health state utility. CONCLUSION For patients with a < 4cm, nonfunctional, benign-appearing mass, one-time follow-up evaluation involving a noncontrast computed tomography and biochemical evaluation is cost-effective. Strategies requiring more surveillance accrue more cost without incremental benefit.
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Affiliation(s)
| | - Carolyn Seib
- UCSF Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Holly Rochefort
- UCSF Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Jessica Gosnell
- UCSF Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Wen T Shen
- UCSF Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - James G Kahn
- UCSF Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA
| | - Quan-Yang Duh
- UCSF Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Insoo Suh
- UCSF Department of Surgery, University of California, San Francisco, San Francisco, CA
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Taffurelli G, Ricci C, Casadei R, Selva S, Minni F. Open adrenalectomy in the era of laparoscopic surgery: a review. Updates Surg 2017; 69:135-143. [DOI: 10.1007/s13304-017-0440-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/01/2017] [Indexed: 12/27/2022]
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SBRT for oligoprogressive oncogene addicted NSCLC. Lung Cancer 2017; 106:50-57. [PMID: 28285694 DOI: 10.1016/j.lungcan.2017.02.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/05/2017] [Indexed: 12/17/2022]
Abstract
Lung cancer is one of the leading causes of cancer death in men and women and treatment outcome continues to lag behind other common cancer types. A subset of lung adenocarcinoma patients exhibit a somatic mutation in EGFR or an ALK rearrangement. In these patients, targeted TKI therapy results in higher response rates, improved PFS and reduced side effects compared with platinum-based chemotherapy. Despite initial activity of the TKIs, ultimately all patients present with disease progression after about a year on TKI therapy due to resistance development. About 15-47% of patients present with limited oligoprogressive disease (OPD): such patients show only a limited number of metastases with progression in radiological imaging. Radical local treatment to all oligoprogressive lesions is thought to eradicate the de-differentiated clones and restore overall sensitivity of the metastatic disease. Retrospective studies suggest that aggressive local treatment using stereotactic body radiotherapy (SBRT), surgery or others can be used to eradicate TKI-resistant subpopulations enabling prolonged TKI treatment "beyond progression", which may lead to increased PFS and overall survival. This review focuses on the biological background of resistance development, systemic and local treatment options with a focus on SBRT, as well as challenges in defining the state of OPD and current clinical studies in oligoprogressive oncogene addicted NSCLC.
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Men M, Ye X, Fan W, Zhang K, Bi J, Yang X, Zheng A, Huang G, Wei Z. Short-Term Outcomes and Safety of Computed Tomography-Guided Percutaneous Microwave Ablation of Solitary Adrenal Metastasis from Lung Cancer: A Multi-Center Retrospective Study. Korean J Radiol 2016; 17:864-873. [PMID: 27833402 PMCID: PMC5102914 DOI: 10.3348/kjr.2016.17.6.864] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 07/09/2016] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To retrospectively evaluate the short-term outcomes and safety of computed tomography (CT)-guided percutaneous microwave ablation (MWA) of solitary adrenal metastasis from lung cancer. MATERIALS AND METHODS From May 2010 to April 2014, 31 patients with unilateral adrenal metastasis from lung cancer who were treated with CT-guided percutaneous MWA were enrolled. This study was conducted with approval from local Institutional Review Board. Clinical outcomes and complications of MWA were assessed. RESULTS Their tumors ranged from 1.5 to 5.4 cm in diameter. After a median follow-up period of 11.1 months, primary efficacy rate was 90.3% (28/31). Local tumor progression was detected in 7 (22.6%) of 31 cases. Their median overall survival time was 12 months. The 1-year overall survival rate was 44.3%. Median local tumor progression-free survival time was 9 months. Local tumor progression-free survival rate was 77.4%. Of 36 MWA sessions, two (5.6%) had major complications (hypertensive crisis). CONCLUSION CT-guided percutaneous MWA may be fairly safe and effective for treating solitary adrenal metastasis from lung cancer.
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Affiliation(s)
- Min Men
- Department of Oncology, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, Shandong Province 250021, China
| | - Xin Ye
- Department of Oncology, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, Shandong Province 250021, China
| | - Weijun Fan
- Imaging and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province 510060, China
| | - Kaixian Zhang
- Department of Oncology, Teng Zhou Central People's Hospital Affiliated with Jining Medical College, Tengzhou, Shandong Province 277500, China
| | - Jingwang Bi
- Department of Oncology, Jinan Military General Hospital of Chinese People's Liberation Army, Jinan, Shandong Province 250021, China
| | - Xia Yang
- Department of Oncology, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, Shandong Province 250021, China
| | - Aimin Zheng
- Department of Oncology, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, Shandong Province 250021, China
| | - Guanghui Huang
- Department of Oncology, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, Shandong Province 250021, China
| | - Zhigang Wei
- Department of Oncology, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, Shandong Province 250021, China
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Barmpari ME, Savvidis C, Dede AD, Markogiannakis H, Dikoglou C, Xekouki P, Stratakis CA, Andreas M, Malaktari-Skarantavou S. Adrenal malignant melanoma masquerading as a pheochromocytoma in a patient with a history of a multifocal papillary and medullary thyroid carcinoma. Hormones (Athens) 2016; 15:283-290. [PMID: 27376430 PMCID: PMC6354246 DOI: 10.14310/horm.2002.1653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 12/09/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Adrenal masses usually represent benign and nonfunctional adrenal adenomas; however, primary or metastatic malignancy should also be considered. Discovery of an adrenal mass needs further evaluation in order to exclude malignancy and hormonal secretion. We present a rare case of a possibly primary adrenal malignant melanoma with imaging and biochemical features of a pheochromocytoma. CASE REPORT A 61-year-old male farmer was referred for evaluation of a mass in the right supraclavicular region and a left adrenal lesion. The patient had a history of a multifocal papillary and medullary thyroid carcinoma. Laboratory tests revealed increased 24hour urinary dopamine and also increased serum calcitonin and neuron specific enolase. A pathology report of the resected right supraclavicular mass and left adrenal showed a malignant melanoma. CONCLUSION This is a case of a possibly primary adrenal malignant melanoma with imaging and biochemical features of a pheochromocytoma. Although this case is very rare and there are rigid diagnostic criteria for the diagnosis of primary adrenal melanoma, it underlines the fact that the differential diagnosis of a dopamine secreting adrenal mass should include primary or metastatic malignant melanoma in order to determine the best diagnostic approach for the patient and select the most appropriate surgical management.
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Affiliation(s)
- Maria E Barmpari
- Department of Endocrinology and Metabolism, Hippokration Hospital, Athens, Greece.
| | - Christos Savvidis
- Department of Endocrinology and Metabolism, Hippokration Hospital, Athens, Greece
| | - Anastasia D Dede
- Department of Endocrinology and Metabolism, Hippokration Hospital, Athens, Greece
| | - Haridimos Markogiannakis
- Department of Endocrine Surgery, First Department of Propaedeutic Surgery, Hippokration Hospital, Athens Medical School, University of Athens, Athens, Greece
| | | | - Paraskevi Xekouki
- Section of Endocrinology and Genetics, Program on Developmental Endocrinology Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Constantine A Stratakis
- Section of Endocrinology and Genetics, Program on Developmental Endocrinology Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Manouras Andreas
- Department of Endocrine Surgery, First Department of Propaedeutic Surgery, Hippokration Hospital, Athens Medical School, University of Athens, Athens, Greece
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Thomas AZ, Blute ML, Seitz C, Habra MA, Karam JA. Management of the Incidental Adrenal Mass. Eur Urol Focus 2016; 1:223-230. [PMID: 28723391 DOI: 10.1016/j.euf.2015.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/09/2015] [Accepted: 12/11/2015] [Indexed: 12/14/2022]
Abstract
CONTEXT Incidentally discovered adrenal masses are becoming more common in clinical practice. OBJECTIVE To review the management of the incidental adrenal mass, including initial evaluation, surveillance, medical therapy, and surgical therapy. EVIDENCE ACQUISITION A literature search of English-language publications that included the keywords adrenal incidentaloma and incidental adrenal mass was performed through July 2015 using PubMed. Relevant original articles and guidelines on the management of the incidental adrenal mass were ultimately selected for analysis, with the consensus of all authors. EVIDENCE SYNTHESIS Data from the manuscripts included in this review were synthesized, and findings were categorized into metabolic evaluation, imaging, biopsy, surgical considerations, and follow-up recommendations. CONCLUSIONS Ideally, management of patients with adrenal incidentalomas should involve a multidisciplinary approach with experienced surgeons, radiologists, and endocrinologists to determine whether such lesions are benign or malignant and functional or nonfunctional and/or whether they require surgical resection. PATIENT SUMMARY Management of patients with adrenal incidentalomas should involve a multidisciplinary approach with surgeons, radiologists, and endocrinologists to determine whether such lesions are benign or malignant and functional or nonfunctional and/or whether they require surgical resection.
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Affiliation(s)
- Arun Z Thomas
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael L Blute
- Department of Urology, Massachusetts General Hospital, Boston, MA, USA
| | - Christian Seitz
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Mouhammed Amir Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jose A Karam
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Management of suspected adrenal metastases at 2 academic medical centers. Am J Surg 2016; 211:664-70. [PMID: 26822269 DOI: 10.1016/j.amjsurg.2015.11.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 11/11/2015] [Accepted: 11/23/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND The optimal management of suspected adrenal metastases remains controversial. METHODS This is a retrospective bi-institutional review of 37 patients who underwent adrenalectomy for suspected adrenal metastasis between 2001 and 2014. RESULTS Three (8%) patients had benign adenomas on final pathology. At a median follow-up of 21 months, 7 (32%) patients were alive with no evidence of disease and 7 (32%) were alive with recurrent disease. Recurrence-free survival (RFS) was 8 months; decreased RFS was associated with positive margins and size ≥6 cm. Overall survival (OS) was 29 months; decreased OS was associated with capsular disruption. There were no differences in RFS or OS by surgical approach. CONCLUSIONS The favorable OS supports adrenalectomy in select patients with suspected adrenal metastases. Minimally invasive adrenalectomy is safe and effective, but the surgical approach should be based on the ability to achieve a margin-negative resection with avoidance of capsular disruption.
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Local Therapy Options for Oligometastatic Disease in the Liver. CURRENT COLORECTAL CANCER REPORTS 2015. [DOI: 10.1007/s11888-015-0279-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Solaini L, Ministrini S, Tomasoni M, Merigo G, Gaverini G, Bertoloni GP, Tiberio GAM. Adrenalectomy for metastasis: long-term results and predictors of survival. Endocrine 2015; 50:187-192. [PMID: 25863489 DOI: 10.1007/s12020-015-0596-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 03/31/2015] [Indexed: 12/17/2022]
Abstract
The purpose of this study was to analyze our experience with surgically treated isolated adrenal metastases in order to find those factors which can significantly affect survival. This method includes a retrospective single-center chart review. We evaluated how overall survival and disease-free survival (DFS) were influenced by demographic, tumor, and procedure-related variables. Thirty-seven adrenalectomies were performed in 34 patients. Procedures included 25 laparoscopic and 12 open adrenalectomies. Median follow-up was 49 months. Median overall survival was 63 months. Patients submitted to laparoscopic approach had a median survival of 57 months while it was 65 months for those who underwent open procedure (p = 0.67). DFS was 30 months, and these were 35 and 25 months after laparoscopic approach and open approach, respectively (p = 0.59). The concurrent resection of the adrenal metastasis with the primary tumor was the only factor influencing DFS (HR 6.8 95 % CI 1.2-37.3, p = 0.02). Patients with non-small cell lung cancer (n = 15) had a median survival of 63 months and DFS of 35 months. Our experience confirms that adrenalectomy, regardless of the surgical approach, can offer durable disease-free and overall survival outcomes for surgical candidates with isolated adrenal metastases.
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Affiliation(s)
- Leonardo Solaini
- Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia, Pl.e Spedali Civili 1, Brescia, Italy,
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Pędziwiatr M, Wierdak M, Natkaniec M, Matłok M, Białas M, Major P, Budzyński P, Hubalewska-Dydejczyk A, Budzyński A. Laparoscopic transperitoneal lateral adrenalectomy for malignant and potentially malignant adrenal tumours. BMC Surg 2015; 15:101. [PMID: 26314582 PMCID: PMC4551373 DOI: 10.1186/s12893-015-0088-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 08/21/2015] [Indexed: 12/05/2022] Open
Abstract
Background Laparoscopic adrenalectomy is still controversial in cases where malignancy is suspected. However, many proponents of this technique argue that in the hands of an experienced surgeon, laparoscopy can be safely performed. The aim of this study is to present our own experience with the application of laparoscopic surgery for the treatment of malignant and potentially malignant adrenal tumours. Methods Our analysis included 52 patients who underwent laparoscopic adrenalectomy in 2003–2014 due to a malignant or potentially malignant adrenal tumour. Inclusion criteria were primary adrenal malignancy, adrenal metastasis or pheochromocytoma with a PASS score greater than 6. We analyzed the conversion rate, intra- and postoperative complications, intraoperative blood loss and R0 resection rate. Survival was estimated using the Kaplan-Meier method. Results Conversion was necessary in 5 (9.7 %) cases. Complications occurred in a total of 6 patients (11.5 %). R0 resection was achieved in 41 (78.8 %) patients and R1 resection in 9 (17.3 %) patients. In 2 (3.9 %) cases R2 resection was performed. The mean follow-up time was 32.9 months. Survival depended on the type of tumour and was comparable with survival after open adrenalectomy presented in other studies. Conclusions We consider that laparoscopic surgery for adrenal malignancy can be an equal alternative to open surgery and in the hand of an experienced surgeon it guarantees the possibility of noninferiority. Additionally, starting a procedure with laparoscopy allows for minimally invasive evaluation of peritoneal cavity. The key element in surgery for any malignancy is not the surgical access itself but the proper technique.
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Affiliation(s)
- Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501, Kraków, Poland.
| | - Mateusz Wierdak
- Department of Physiology, Jagiellonian University, Grzegórzecka 16, 31-531, Kraków, Poland
| | - Michał Natkaniec
- 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501, Kraków, Poland
| | - Maciej Matłok
- 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501, Kraków, Poland
| | - Magdalena Białas
- Department of Pathology, Jagiellonian University, Grzegórzecka 16, 31-531, Kraków, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501, Kraków, Poland
| | - Piotr Budzyński
- 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501, Kraków, Poland
| | | | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501, Kraków, Poland
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Techniques to perform a laparoscopic right adrenalectomy for metastases abutting the liver, renal vein, and posterior vena cava. Surg Endosc 2015; 30:1226. [PMID: 26139482 DOI: 10.1007/s00464-015-4311-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 04/08/2015] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Introduction Laparoscopic adrenalectomy (LA) may be associated with reduction in postoperative pain, morbidity, length of stay, and cost compared to open adrenalectomy, and, as a result, has become a preferred approach for benign tumors. Though recent series have reported safety and oncologic non-inferiority with a minimally invasive approach to malignant and metastatic adrenal tumors, relative contraindications to LA include malignancy, large size, and invasion or abutment of vital structures. METHODS/RESULTS We demonstrate techniques to perform LA in an obese patient with a large ([6 cm) solitary breast metastasis to the right adrenal gland that was adherent to the liver, inferior vena cava (IVC), and right renal vein. The tumor was growing behind the infrahepatic IVC and was abutting the confluence of the renal vein/IVC. The patient was monitored on systemic treatment with no new sites of disease and after achieving a maximal response to neoadjuvant treatment. Laparoscopic techniques to safely approach adrenal tumors adherent to the liver, IVC, and renal vein are stepwise demonstrated, including appropriate patient positioning and port site selection. The tumor was excised with negative margins, and the patient was discharged on postoperative day 1 with minimal pain medication and tolerating a regular diet. CONCLUSION Though malignancy is a relative contraindication to LA, even large right-sided adrenal tumors abutting the liver and growing behind the IVC can be safely approached while adhering to oncologic principles, as is demonstrated in this video.
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Ploumidis A, Spinoit AF, De Naeyer G, Ficarra V, Mottrie A. Robot-assisted radical adrenalectomy with clamping of the vena cava for excision of a metastatic adrenal vein thrombus: a case report. Int J Med Robot 2015; 11:413-7. [PMID: 25727563 DOI: 10.1002/rcs.1641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 12/06/2014] [Accepted: 12/12/2014] [Indexed: 11/05/2022]
Abstract
BACKGROUND Renal or adrenal neoplastic vein thrombi are relative contra-indications for laparoscopic treatment. To the best of our knowledge, we present the first robot-assisted radical adrenalectomy (RARA) with the presence of a thrombus in the adrenal vein. METHODS A 54 year-old male with a history of laparoscopic left radical nephrectomy for clear cell carcinoma was referred to our department with a diagnosed right adrenal tumour extending into the adrenal vein. A RARA was planned through a trans-peritoneal approach, and an en bloc resection of the adrenal and its vein with clamping of the vena cava was performed. RESULTS Console time was 94 min and the estimated blood loss was 44 ml. The pathology report confirmed clear cell carcinoma with negative surgical margins. Convalescence was uneventful. CONCLUSION RARA with thrombectomy and vascular reconstruction can be safe, effective and feasible in experienced hands, using robotic bulldogs.
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Affiliation(s)
- Achilles Ploumidis
- Department of Urology, OLV Vattikuti Robotic Surgery Institute, Aalst, Belgium
| | - Anne-Françoise Spinoit
- Department of Urology, OLV Vattikuti Robotic Surgery Institute, Aalst, Belgium.,Department of Urology, Ghent University Hopsital, Ghent, Belgium
| | - Geert De Naeyer
- Department of Urology, OLV Vattikuti Robotic Surgery Institute, Aalst, Belgium
| | - Vincenzo Ficarra
- Department of Urology, OLV Vattikuti Robotic Surgery Institute, Aalst, Belgium.,Department of Experimental and Clinical Medical Sciences, Urologic Clinic, University of Padoua, Italy
| | - Alexandre Mottrie
- Department of Urology, OLV Vattikuti Robotic Surgery Institute, Aalst, Belgium
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Iyengar P, Kavanagh BD, Wardak Z, Smith I, Ahn C, Gerber DE, Dowell J, Hughes R, Abdulrahman R, Camidge DR, Gaspar LE, Doebele RC, Bunn PA, Choy H, Timmerman R. Phase II trial of stereotactic body radiation therapy combined with erlotinib for patients with limited but progressive metastatic non-small-cell lung cancer. J Clin Oncol 2014; 32:3824-30. [PMID: 25349291 DOI: 10.1200/jco.2014.56.7412] [Citation(s) in RCA: 220] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Patients with stage IV non-small-cell lung cancer (NSCLC) who progress through first-line therapy have poor progression-free survival (PFS) and overall survival (OS), most commonly failing in original sites of gross disease. Cytoreduction with stereotactic body radiation therapy (SBRT) may help systemic agents delay relapse. PATIENTS AND METHODS Patients in our single arm phase II study had stage IV NSCLC with no more than six sites of extracranial disease who failed early systemic chemotherapy and were able to receive SBRT and concurrent erlotinib until disease progression. After erlotinib commencement, SBRT with equipotent fractionation was delivered to all sites of disease. PFS, OS, and other end points were evaluated. RESULTS Twenty-four patients (13 men and 11 women) with a median age of 67 years (range, 56-86 years) were enrolled with median follow-up of 11.6 months. All patients had progressed through platinum-based chemotherapy. A total of 52 sites were treated with 16 of 24 patients receiving SBRT to more than one site. Lung parenchyma was most often irradiated. Median PFS was 14.7 months, and median OS was 20.4 months. Most patients progressed in new distant sites with only three of 47 measurable lesions recurring within the SBRT field. Two grade 3 toxicities were radiation related. Zero of 13 patients tested were positive for an EGFR mutation. CONCLUSION Use of SBRT with erlotinib for unselected patients with stage IV NSCLC as a second- or subsequent line therapy resulted in dramatic changes in patterns of failure, was well tolerated, and resulted in high PFS and OS, substantially greater than historical values for patients who only received systemic agents.
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Affiliation(s)
- Puneeth Iyengar
- Puneeth Iyengar, Zabi Wardak, Irma Smith, Chul Ahn, David E. Gerber, Jonathan Dowell, Randall Hughes, Ramzi Abdulrahman, Hak Choy, Robert Timmerman, University of Texas Southwestern Medical Center, Dallas, TX; Brian D. Kavanagh, D. Ross Camidge, Laurie E. Gaspar, Robert C. Doebele, and Paul A. Bunn, University of Colorado School of Medicine, Aurora, CO
| | - Brian D Kavanagh
- Puneeth Iyengar, Zabi Wardak, Irma Smith, Chul Ahn, David E. Gerber, Jonathan Dowell, Randall Hughes, Ramzi Abdulrahman, Hak Choy, Robert Timmerman, University of Texas Southwestern Medical Center, Dallas, TX; Brian D. Kavanagh, D. Ross Camidge, Laurie E. Gaspar, Robert C. Doebele, and Paul A. Bunn, University of Colorado School of Medicine, Aurora, CO
| | - Zabi Wardak
- Puneeth Iyengar, Zabi Wardak, Irma Smith, Chul Ahn, David E. Gerber, Jonathan Dowell, Randall Hughes, Ramzi Abdulrahman, Hak Choy, Robert Timmerman, University of Texas Southwestern Medical Center, Dallas, TX; Brian D. Kavanagh, D. Ross Camidge, Laurie E. Gaspar, Robert C. Doebele, and Paul A. Bunn, University of Colorado School of Medicine, Aurora, CO
| | - Irma Smith
- Puneeth Iyengar, Zabi Wardak, Irma Smith, Chul Ahn, David E. Gerber, Jonathan Dowell, Randall Hughes, Ramzi Abdulrahman, Hak Choy, Robert Timmerman, University of Texas Southwestern Medical Center, Dallas, TX; Brian D. Kavanagh, D. Ross Camidge, Laurie E. Gaspar, Robert C. Doebele, and Paul A. Bunn, University of Colorado School of Medicine, Aurora, CO
| | - Chul Ahn
- Puneeth Iyengar, Zabi Wardak, Irma Smith, Chul Ahn, David E. Gerber, Jonathan Dowell, Randall Hughes, Ramzi Abdulrahman, Hak Choy, Robert Timmerman, University of Texas Southwestern Medical Center, Dallas, TX; Brian D. Kavanagh, D. Ross Camidge, Laurie E. Gaspar, Robert C. Doebele, and Paul A. Bunn, University of Colorado School of Medicine, Aurora, CO
| | - David E Gerber
- Puneeth Iyengar, Zabi Wardak, Irma Smith, Chul Ahn, David E. Gerber, Jonathan Dowell, Randall Hughes, Ramzi Abdulrahman, Hak Choy, Robert Timmerman, University of Texas Southwestern Medical Center, Dallas, TX; Brian D. Kavanagh, D. Ross Camidge, Laurie E. Gaspar, Robert C. Doebele, and Paul A. Bunn, University of Colorado School of Medicine, Aurora, CO
| | - Jonathan Dowell
- Puneeth Iyengar, Zabi Wardak, Irma Smith, Chul Ahn, David E. Gerber, Jonathan Dowell, Randall Hughes, Ramzi Abdulrahman, Hak Choy, Robert Timmerman, University of Texas Southwestern Medical Center, Dallas, TX; Brian D. Kavanagh, D. Ross Camidge, Laurie E. Gaspar, Robert C. Doebele, and Paul A. Bunn, University of Colorado School of Medicine, Aurora, CO
| | - Randall Hughes
- Puneeth Iyengar, Zabi Wardak, Irma Smith, Chul Ahn, David E. Gerber, Jonathan Dowell, Randall Hughes, Ramzi Abdulrahman, Hak Choy, Robert Timmerman, University of Texas Southwestern Medical Center, Dallas, TX; Brian D. Kavanagh, D. Ross Camidge, Laurie E. Gaspar, Robert C. Doebele, and Paul A. Bunn, University of Colorado School of Medicine, Aurora, CO
| | - Ramzi Abdulrahman
- Puneeth Iyengar, Zabi Wardak, Irma Smith, Chul Ahn, David E. Gerber, Jonathan Dowell, Randall Hughes, Ramzi Abdulrahman, Hak Choy, Robert Timmerman, University of Texas Southwestern Medical Center, Dallas, TX; Brian D. Kavanagh, D. Ross Camidge, Laurie E. Gaspar, Robert C. Doebele, and Paul A. Bunn, University of Colorado School of Medicine, Aurora, CO
| | - D Ross Camidge
- Puneeth Iyengar, Zabi Wardak, Irma Smith, Chul Ahn, David E. Gerber, Jonathan Dowell, Randall Hughes, Ramzi Abdulrahman, Hak Choy, Robert Timmerman, University of Texas Southwestern Medical Center, Dallas, TX; Brian D. Kavanagh, D. Ross Camidge, Laurie E. Gaspar, Robert C. Doebele, and Paul A. Bunn, University of Colorado School of Medicine, Aurora, CO
| | - Laurie E Gaspar
- Puneeth Iyengar, Zabi Wardak, Irma Smith, Chul Ahn, David E. Gerber, Jonathan Dowell, Randall Hughes, Ramzi Abdulrahman, Hak Choy, Robert Timmerman, University of Texas Southwestern Medical Center, Dallas, TX; Brian D. Kavanagh, D. Ross Camidge, Laurie E. Gaspar, Robert C. Doebele, and Paul A. Bunn, University of Colorado School of Medicine, Aurora, CO
| | - Robert C Doebele
- Puneeth Iyengar, Zabi Wardak, Irma Smith, Chul Ahn, David E. Gerber, Jonathan Dowell, Randall Hughes, Ramzi Abdulrahman, Hak Choy, Robert Timmerman, University of Texas Southwestern Medical Center, Dallas, TX; Brian D. Kavanagh, D. Ross Camidge, Laurie E. Gaspar, Robert C. Doebele, and Paul A. Bunn, University of Colorado School of Medicine, Aurora, CO
| | - Paul A Bunn
- Puneeth Iyengar, Zabi Wardak, Irma Smith, Chul Ahn, David E. Gerber, Jonathan Dowell, Randall Hughes, Ramzi Abdulrahman, Hak Choy, Robert Timmerman, University of Texas Southwestern Medical Center, Dallas, TX; Brian D. Kavanagh, D. Ross Camidge, Laurie E. Gaspar, Robert C. Doebele, and Paul A. Bunn, University of Colorado School of Medicine, Aurora, CO
| | - Hak Choy
- Puneeth Iyengar, Zabi Wardak, Irma Smith, Chul Ahn, David E. Gerber, Jonathan Dowell, Randall Hughes, Ramzi Abdulrahman, Hak Choy, Robert Timmerman, University of Texas Southwestern Medical Center, Dallas, TX; Brian D. Kavanagh, D. Ross Camidge, Laurie E. Gaspar, Robert C. Doebele, and Paul A. Bunn, University of Colorado School of Medicine, Aurora, CO
| | - Robert Timmerman
- Puneeth Iyengar, Zabi Wardak, Irma Smith, Chul Ahn, David E. Gerber, Jonathan Dowell, Randall Hughes, Ramzi Abdulrahman, Hak Choy, Robert Timmerman, University of Texas Southwestern Medical Center, Dallas, TX; Brian D. Kavanagh, D. Ross Camidge, Laurie E. Gaspar, Robert C. Doebele, and Paul A. Bunn, University of Colorado School of Medicine, Aurora, CO.
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[Adrenalectomy for adrenal metastases: is the laparoscopic approach beneficial for all patients?]. Prog Urol 2014; 24:1069-75. [PMID: 25242339 DOI: 10.1016/j.purol.2014.08.236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/29/2014] [Accepted: 08/19/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Laparoscopy has become the gold-standard approach for excision of benign adrenal tumors but the question of its safety for malignant lesions is still controversial. Our aim was to evaluate the oncologic outcome of laparoscopic adrenalectomy for adrenal metastasis and to look for predictors of a negative surgical outcome. PATIENTS AND METHODS We retrospectively reviewed the charts of all patients who underwent laparoscopic adrenalectomy for suspicion of adrenal metastasis between 2007 and 2013 at a single academic institution. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. Univariate analysis was performed to determine risk factors of negative surgical outcome (positive surgical margins, complications, conversion, significant blood loss) and predictors of RFS and CSS. RESULTS Thirteen patients underwent 14 laparoscopic adrenalectomies. All patients were operated by a single highly experienced surgeon. Complications occurred in 2 patients (15%): 2 blood transfusions (Clavien-score=2). There were 3 positive surgical margins (21%). Mean length of hospital stay was 4.3 days. Unadjusted RFS and CSS were respectively 48.4% and 83.3% at 1 year, 39.5% and 66.7% at 5 years. In univariate analysis, tumor size was the only risk factor of complication (P=.009) and conversion (P=0.009). Capsule invasion and tumor size were risk factors of positive surgical margins (P=0.01 and P<0.0001). One hundred percent of complications, conversion and positive surgical margins occurred in tumor>7.5 cm on preoperative CT-scan. No predictors of RFS and CSS was found in univariate analysis. CONCLUSION Laparoscopic adrenalectomy for adrenal metastasis achieves good surgical and oncologic outcomes. When performed by highly experienced surgeon, complications and positive surgical margins occur only in tumors>7.5 cm. These patients may benefit from an open surgical approach.
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