Page 20 - World Journal of Laparoscopic Surgery

REVIEW ARTICLE Open versus Laparoscopic Adrenalectomy for Multiple Adrenal Disorders

Open versus Laparoscopic Adrenalectomy for

Multiple Adrenal Disorders

Malikendra Patel
Laparoscopic Surgeon and Endoscopist, Ipsaa Endoscopy Center, Khandwa, Madhya Pradesh, India

Abstract
In this review article, twelve articles were reviewed from 1998-march 2009 and analyzed, treatment and management of different
adrenal surgical problems were reviewed including pheochromocytoma, functional adenoma, adrenal cortical carcinoma, adrenal
metastasis and primary adrenal malignancies. The studies were taken from Journal of clinical endocrinology and metabolism, annals of
surgical oncology, Google, Springerlink, The Hongkong medical diary, ANZ journal of surgery. Evaluation of the safety of laparoscopic
adrenalectomy in comparison open treatment was done.
Conclusion: Laparoscopic adrenalectomy should be the treatment of choice for all benign and certain malignant adrenal tumors.
Laparoscopic resection of large adrenal tumors needs experienced surgeons in open and advanced laparoscopic surgery.
Keywords: Adrenalectomy, functional adenoma, adrenal cortical carcinoma, adrenal metastasis, pheochromacytoma, open versus
laparoscopic surgery.

INTRODUCTION subsequent management. Variables to consider are the size of
the lesion, its imaging characteristics, and its growth rate.
Adrenal masses are one of the most prevalent of all human Traditionally, the size of the lesion has been considered to be
tumors. The prevalence of adrenal masses approaches 3% in the major determinant of the presence of a malignant tumor.
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middle age, and increases to as much as 7% in the elderly. It is More than 60% of the adrenal masses less than 4 cm are benign
anticipated that the management of adrenal masses will be a adenomas, while less than 2% represent primary adrenocortical
growing clinical challenge in our aging society because of its carcinomas. In contrast, the risk for carcinoma increases to 25%
high prevalence in the elderly and the increased use of abdominal in lesions that are greater than 6 cm, while benignadenomas
imaging studies.
account for less than 15%. Therefore, the generally accepted
A. Functional Adenoma recommendation is to excise lesions that are larger than 6 cm.
Lesions that are less than 4 cm and are defined as low risk by
If history or physical examination of a patient with a unilateral imaging criteria are unlikely to have malignant potential and are
adrenal mass shows signs and symptoms suggestive of generallynot resected. For lesions between 4 cm and 6 cm, either
glucocorticoid, mineralocorticoid, adrenal sex hormone that is close follow-up or adrenalectomy is considered a reasonable
confirmed biochemically, adrenalectomy is often considered approach. Adrenalectomy should be strongly considered if the
the treatment of choice. In the absence of clinical symptoms; imaging findings suggest that the lesion is not an adenoma.
treatment decisions for patients with biochemical evidence of
cortisol hypersecretion present a vexing problem. While
adrenalectomy has been demonstrated to correct biochemical D. Metastases
abnormalities, its effect on long-term outcome and quality of The adrenal glands are frequent sites for metastases from many
life is unknown. Either adrenalectomy or careful observation cancers. Lymphoma and carcinoma of the lung and breast
has been suggested as a treatment option. account for a large proportion of adrenal metastases. Other
primary cancers include melanoma, leukemia, and kidney and
B. Pheochromocytoma
ovarian carcinoma. In a review of 1000 consecutive autopsies
Pheochromocytoma is among the most life-threatening of patients with carcinoma, the adrenal glands were involved in
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endocrine diseases, particularly if it remains undiagnosed. 27% of the cases. The incidence of adrenal metastases in
Patients even with “silent” pheochromocytomas are at risk for patients with breast and lung cancer is approximately 39 and
a hypertensive crisis and should undergo adrenalectomy. 35%, respectively. Among cancer patients, 50-75% of clinically
4,5
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in apparent adrenal masses are metastases. There is no
C. Adrenocortical Carcinoma
established clinical benefit to be derived form adrenalectomy in
In patients with nonfunctioning adrenal masses, distinguishing those patients who are diagnosed with a metastasis from a
between malignant and benign primary adrenal tumors guides known primary neoplasm. Nevertheless; long-term survival has
World Journal of Laparoscopic Surgery, September-December 2009;2(3):19-22 19