Introduction/Aim: This study aimed to determine if laparoscopic adrenalectomy (LA) is feasible for the treatment of adrenal malignancies and metastasis, and to review the final pathology findings in order to clarify the indications for surgery. Materials and Method: The medical records of all patients that underwent LA at 3 university hospitals between January 1, 2008, and May 1, 2015, were retrospectively reviewed. Results: In total, 189 laparoscopic adrenalectomies were completed successfully. Mean duration of surgery was 79.3 ± 38.6 min and mean estimated intraoperative blood loss was 39.9 ml. Intraoperatively, 4 patients had major complications: spleen injury (n = 1), renal vein injury (n = 2) and diaphragm injury (n = 2). Histopathological examination showed that there were 20 different types of lesions. Surgical margins (SMs) were tumor free in 95.2% of the patients. Moreover, SMs were tumor free in all patients with adrenocortical carcinomas; however, positive margins were noted in 7 of 23 patients (30.4%) with malignant adrenal tumors. Conclusions: The present findings support the use of laparoscopy for metastatic adrenal masses, despite a high positive margin rate. LA is a safe, feasible and cost-effective procedure for the management of benign and malignant adrenal masses.

Keywords:
Laparoscopy, Adrenalectomy, Lung cancer, Adrenal metastasis, Adrenocortical carcinoma
1.
Bittner JG 4th, Brunt LM: Evaluation and management of adrenal incidentaloma. J Surg Oncol 2012;106:557-564.
2.
Valeri A, Bergamini C, Manca G, Mannelli M, Presenti L, Peri A, Borrelli A, Tonelli P: Adrenal incidentaloma: the influence of a decision-making algorithm on the short-term outcome of laparoscopy. J Laparoendosc Adv Surg Tech A 2005;15:451-459.
3.
Pedziwiatr M, Natkaniec M, Kisialeuski M, Major P, Matlok M, Kolodziej D, Zub-Pokrowiecka A, Budzynski P, Budzynski A: Adrenal incidentalomas: should we operate on small tumors in the era of laparoscopy? Int J Endocrinol 2014;2014:658483.
4.
Chuan-Yu S, Yat-Faat H, Wei-Hong D, Yuan-Cheng G, Qing-Feng H, Ke X, Bin G, Guo-Wei X: Laparoscopic adrenalectomy for adrenal tumors. Int J Endocrinol 2014;2014:241854.
5.
Birsen O, Akyuz M, Dural C, Aksoy E, Aliyev S, Mitchell J, Siperstein A, Berber E: A new risk stratification algorithm for the management of patients with adrenal incidentalomas. Surgery 2014;156:959-965.
6.
Lombardi CP, Raffaelli M, De Crea C, Bellantone R: Role of laparoscopy in the management of adrenal malignancies. J Surg Oncol 2006;94:128-131.
7.
Maestroni U, Ziglioli F, Dinale F, Ferretti S, Frattini A, Cortellini P: Is laparoscopy contraindicated in giant adrenal masses? Surg Laparosc Endos Percutan Tech 2010;20:288-290.
8.
Goenka AH, Shah SN, Remer EM, Berber E: Adrenal imaging: a primer for oncosurgeons. J Surg Oncol 2012;106:543-548.
9.
Kerkhofs TM, Roumen RM, Demeyere TB, van der Linden AN, Haak HR: Adrenal tumors with unexpected outcome: a review of the literature. Int J Endocrinol 2015;2015:710514.
10.
Cao D, Li L, Liu L, Xiao W, He X, Tang Z, Yuan J, Li X, Qiang W: Solitary extramedullary plasmacytoma of the adrenal gland: a rare case report with review of the literature. Int J Clin Exp Pathol 2014;7:9072-9075.
11.
Ding X, Hou Y, Ma X, Huipeng Z, Wang C, Wang Y: Adult adrenal ganglioneuroblastoma: a rare case report. Can Urol Assoc J 2015;9:e75-e77.
12.
Feng YC, Yang ZG, Chen TW, Su XY, Deng W, Wang QL: Adrenal sarcomatoid carcinoma: a rare case depicted on multi-detector row computed tomography. Indian J Med Sci 2010;64:37-40.
13.
Fernandez JM, Huescar AM, Ablanedo P, Rabade CJ, Perez Garcia FJ, Rodriguez Martinez JJ, Escaf S: [Primary leiomyosarcoma. A rare tumor of the adrenal gland]. Arch Esp Urol 1998;51:1029-1031.
14.
Galea N, Noce V, Ciolina F, Liberali S, Francone M: Giant adrenal cavernous hemangioma: a rare abdominal mass. Urology 2013;82:e3-e4.
15.
Pant L, Kalita D, Chopra R, Das A, Jain G: Malignant perivascular epithelioid Cell cumor (PEComa) of the adrenal gland: report of a rare case posing diagnostic challenge with the role of immunohistochemistry in the diagnosis. Endocr Pathol 2015;26:129-134.
16.
Phukan C, Nirmal TJ, Kumar RM, Kekre NS: Peripheral primitive neuroectodermal tumor of the adrenal gland: a rare entity. Indian J Urol 2013;29:357-359.
17.
Sharma N, Dogra PN, Mathur S: Functional adrenal oncocytoma: a rare neoplasm. Indian J Pathol Microbiol 2008;51:531-533.
18.
Sourial MW, van Rossum N, Sabbagh R: Adrenal lymphangioma: a rare cystic lesion of the adrenal. Can J Urol 2013;20:6968-6970.
19.
Treglia G, Oragano L, Fadda G, Raffaelli M, Lombardi CP, Castaldi P, Rufini V: A rare case of solitary fibrous tumor of the adrenal gland detected by (18)F-FDG PET/CT. Clin Nucl Med 2014;39:475-477.
20.
Wakabayashi M, Sekiguchi Y, Shimada A, Ichikawa K, Sugimoto K, Tomita S, Izumi H, Nakamura N, Sawada T, Ohta Y, et al: Diffuse large B-cell lymphoma solely involving bilateral adrenal glands and stomach: report of an extremely rare case with review of the literature. Int J Clin Exp Pathol 2014;7:8190-8197.
21.
Perry KA, El Youssef R, Pham TH, Sheppard BC: Laparoscopic adrenalectomy for large unilateral pheochromocytoma: experience in a large academic medical center. Surg Endosc 2010;24:1462-1467.
22.
Paganini AM, Balla A, Guerrieri M, Lezoche G, Campagnacci R, D'Ambrosio G, Quaresima S, Antonica MV, Lezoche E: Laparoscopic transperitoneal anterior adrenalectomy in pheochromocytoma: experience in 62 patients. Surg Endosc 2014;28:2683-2689.
23.
Wanis KN, Kanthan R: Diagnostic and prognostic features in adrenocortical carcinoma: a single institution case series and review of the literature. World J Surg Oncol 2015;13:117.
24.
Kang T, Gridley A, Richardson WS: Long-term outcomes of laparoscopic adrenalectomy for adrenal masses. J Laparoendosc Adv Surg Tech A 2015;25:182-186.
25.
Hwang EC, Hwang I, Jung SI, Kang TW, Kwon DD, Heo SH, Hwang JE, Kang SG, Kang SH, Lee JG, et al: Prognostic factors for recurrence-free and overall survival after adrenalectomy for metastatic carcinoma: a retrospective cohort pilot study. BMC Urol 2014;14:41.
26.
Miller BS, Ammori JB, Gauger PG, Broome JT, Hammer GD, Doherty GM: Laparoscopic resection is inappropriate in patients with known or suspected adrenocortical carcinoma. World J Surg 2010;34:1380-1385.
27.
Brix D, Allolio B, Fenske W, Agha A, Dralle H, Jurowich C, Langer P, Mussack T, Nies C, Riedmiller H, et al; German Adrenocortical Carcinoma Registry Group: Laparoscopic versus open adrenalectomy for adrenocortical carcinoma: surgical and oncologic outcome in 152 patients. Eur Urol 2010;58:609-615.
28.
Agcaoglu O, Aliyev S, Karabulut K, Mitchell J, Siperstein A, Berber E: Robotic versus laparoscopic resection of large adrenal tumors. Ann Surg Oncol 2012;19:2288-2294.
29.
Rosoff JS, Raman JD, Del Pizzo JJ: Laparoscopic adrenalectomy for large adrenal masses. Curr Urol Rep 2008;9:73-79.
30.
Kawai N, Tozawa K, Yasui T, Moritoki Y, Sasaki H, Yano M, Fujii Y, Kohri K: Laparoscopic adrenalectomy for solitary adrenal metastasis from lung cancer. JSLS 2014;18:pii:e2014.00062.
31.
Solaini L, Ministrini S, Tomasoni M, Merigo G, Gaverini G, Bertoloni GP, Tiberio GA: Adrenalectomy for metastasis: long-term results and predictors of survival. Endocrine 2015;50:187-192.
© 2016 S. Karger AG, Basel
2016
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.