Laparoscopic radical adrenalectomy for malignancy in 31 patients

被引:124
作者
Moinzadeh, A [1 ]
Gill, IS [1 ]
机构
[1] Cleveland Clin Fdn, Glickman Urol Inst, Sect Laparoscop & Robot Surg, Cleveland, OH 44195 USA
关键词
adrenal glands; laparoscopy; adrenalectomy; neoplasm metastasis; adrenal gland neoplasms;
D O I
10.1097/01.ju.0000149038.89467.30
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose: Laparoscopic adrenalectomy for malignancy is controversial. We analyzed our experience with laparoscopic radical adrenalectomy for cancer with an emphasis on predictors of surgical outcome and oncological followup data. Materials and Methods: Since July 1997, 31 patients have undergone a total of 33 laparoscopic adrenalectomies for malignancy. Mean adrenal tumor size was 5 cm (range 1.8 to 9). The laparoscopic approach was transperitoneal in 17 cases, retroperitoneal in 15 and transthoracic in 1. Data were obtained from patient charts, radiographic reports and direct telephone calls to patient families. Results: Associated organ resection (radical nephrectomy) was performed in 3 patients. One case was electively converted to open surgery. There was no operative mortality. The pathological diagnoses were metastatic cancer in 26 cases and primary adrenal malignancy in 7. Current, median followup, available on 30 patients, was 26 months (range 1 to 69). Overall 15 patients (48%) died and 16 (52%) were alive, of whom 13 (42%) showed no evidence of disease. Cancer specific survival at a median followup of 42 months was 53% and 5-year actuarial survival was 40%. Local recurrence was noted in 7 patients (23%). There were no port site metastases. Survival was similar in patients with tumors less than 5 cm vs 5 cm or greater. Survival was not, associated with patient age, tumor size, operative time or surgical approach. Survival was compromised in patients with local recurrence (p = 0.016). Conclusions: Laparoscopic radical adrenalectomy can be performed with acceptable outcomes in the carefully selected patient with a small, organ confined.. solitary adrenal metastasis or primary adrenal carcinoma. To our knowledge the largest series in the literature to date is presented.
引用
收藏
页码:519 / 525
页数:7
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