Öz
Aim: The study was focused on examining the results of surgical management of adrenal tumors treated at our center as well as comparing different types of surgeries especially laparoscopic and open approaches.
Material and Method: We retrospectively analyzed data from 82 patients who underwent surgery for adrenal masses at Dicle University Medical Faculty between 2010 and 2020. Patients were categorized into laparoscopic and open surgery groups based on surgical technique, and further classified as functional/non-functional and benign/malignant according to tumor characteristics. Demographic data, tumor characteristics, surgical outcomes, and complications were evaluated.
Results: The mean age of patients was 45.3±14.2 years, with females comprising 58.5% of the cohort. Laparoscopic surgery was performed in 70.7% of cases, while 29.3% underwent open surgery. The mean operative time was significantly shorter in the laparoscopic group (115.4±32.6 minutes) compared to the open surgery group (148.8±45.3 minutes) (p<0.05). Intraoperative blood loss was significantly lower in the laparoscopic group (150±75 ml vs 325±180 ml, p<0.05). Functional tumors were present in 26.8% of patients, while 73.2% had non-functional tumors. Histopathological evaluation revealed benign tumors in 84.1% of cases and malignant tumors in 15.9%.
Conclusion: Laparoscopic approach represents a safe and effective method for surgical treatment of adrenal masses in selected patients. However, open surgery should be preferred for large tumors and cases with suspected malignancy. Treatment planning should be individualized for each patient, with surgical approach selection based on tumor characteristics and patient-specific factors.
Anahtar Kelimeler
Surgical management adrenal masses laparoscopic adrenalectomy
Etik Beyan
The study protocol was approved by the Ethics Committee of Dicle University Faculty of Medicine (approval number: 197, dated 25.03.2021).
Kaynakça
- Fascetti-Leon F, Scotton G, Pio L, et al. Minimally invasive resection of adrenal masses in infants and children: results of a European multi-center survey. Surg Endosc. 2017;31:4505-12. Erratum in: Surg Endosc. 2017;31:4513.
- Lenert JT, Barnett CC Jr, Kudelka AP, et al. Evaluation and surgical resection of adrenal masses in patients with a history of extra-adrenal malignancy. Surgery. 2001;130:1060-7.
- Economopoulos KP, Mylonas KS, Stamou AA, et al. Laparoscopic versus robotic adrenalectomy: a comprehensive meta-analysis. Int J Surg. 2017;38:95-104.
- Terzolo M, Ali A, Osella G, Mazza E. Prevalence of adrenal carcinoma among incidentally discovered adrenal masses. Arch Surg. 1997;132:914-9.
- Lucchi M, Dini P, Ambrogi MC, et al. Metachronous adrenal masses in resected non-small cell lung cancer patients: therapeutic implications of laparoscopic adrenalectomy. Eur J Cardiothorac Surg. 2005;27:753-6.
- Uttinger KL, Reibetanz J, Diers J, et al. Volume-outcome relationship in adrenal surgery from 2009-2017 in Germany—a retrospective study. Eur J Endocrinol. 2023;188:lvac013.
- Yan H, Cao G, Cui X, et al. Retroperitoneoscopic enucleation adrenalectomy: a viable surgical option for small nonsecreting adrenal tumors with low potential of malignancy. Transl Androl Urol. 2023;12:1713-22.
- Tzelves L, Juliebø-Jones P, Somani B. Editorial: the evolution of minimally invasive urologic surgery: innovations, challenges, and opportunities. Front Surg. 2024;11:1525713.
- Peng L, Liang R, Zhao A, et al. Amplifying Chinese physicians' emphasis on patients' psychological states beyond urologic diagnoses with ChatGPT - a multicenter cross-sectional study. Int J Surg. 2024;110:6501-8.
- Bancos I, Prete A. Approach to the patient with adrenal incidentaloma. J Clin Endocrinol Metab. 2021;106:3331-53.
- Okroj D, Rzepecka A, Kłosowski P, et al. Review of diagnostic modalities for adrenal incidentaloma. J Clin Med. 2023;12:3739.
- Lee JM, Kim MK, Ko SH, et al. Clinical Guidelines for the Management of Adrenal Incidentaloma. Endocrinol Metab (Seoul). 2017;32:200-18.
- Fu SQ, Zhuang CS, Yang XR, et al. Comparison of robot-assisted retroperitoneal laparoscopic adrenalectomy versus retroperitoneal laparoscopic adrenalectomy for large pheochromocytoma: a single-centre retrospective study. BMC Surg. 2020;20:227.
- Danwang C, Agbor VN, Bigna JJ. Obesity and postoperative outcomes of the patients with laparoscopic adrenalectomy: a systematic review and meta-analysis. BMC Surg. 2020;20:194.
- Davey MG, Ryan ÉJ, Donlon NE, et al. Comparing surgical outcomes of approaches to adrenalectomy - a systematic review and network meta-analysis of randomised clinical trials. Langenbecks Arch Surg. 2023;408:180.
- Wang J, Yang B, Sun S, Zhang Y. Perioperative factors influencing the difficulty of retroperitoneal laparoscopic adrenalectomy: a single-center retrospective study. BMC Urol. 2022;22:22.
- Samsel R, Cichocki A, Roszkowska-Purska K, et al. Adrenal metastases - long-term results of surgical treatment, single-centre experience. Contemp Oncol (Pozn). 2020;24:29-33.
- Sabet FA, Majdzadeh R, Mostafazadeh Davani B, et al. Likelihood ratio of computed tomography characteristics for diagnosis of malignancy in adrenal incidentaloma: systematic review and meta-analysis. J Diabetes Metab Disord. 2016;15:12.
- Aydin H, Dural AC, Sahbaz NA, et al. Hormonally active adrenal tumors; challenges and outcomes for different surgical approaches. Sisli Etfal Hastan Tip Bul. 2021;55:325-32.
- Indrawan DH, Prapiska FF, Warli SM et al. Functional and non-functional types of adrenal tumors: a case series [version 1; peer review: 1 approved with reservations, 1 not approved]. F1000Research. 2021;10:675.
- Herrera-Martínez AD, Rebollo Román Á, Pascual Corrales E, et al. Adrenal incidentalomas and other endocrine-related adenomas: how much does cortisol secretion matter?. Cancers (Basel). 2023;15:4735.
- Parente A, Kamarajah SK, Thompson JP, et al. Risk factors for postoperative complications after adrenalectomy for phaeochromocytoma: multicentre cohort study. BJS Open. 2023;7:zrad090.
- Vlk E, Ebbehoj A, Donskov F, et al. Outcome and prognosis after adrenal metastasectomy: nationwide study. BJS Open. 2022;6:zrac047.
- Dages KN, Kohlenberg JD, Young WF Jr, et al. Presentation and outcomes of adrenal ganglioneuromas: a cohort study and a systematic review of literature. Clin Endocrinol (Oxf). 2021;95:47-57.
- Thompson LH, Ranstam J, Almquist M, et al. Impact of adrenalectomy on morbidity in patients with non-functioning adrenal cortical tumors, mild hypercortisolism and Cushing’s syndrome as assessed by national and quality registries. World J Surg. 2021;45:3099-107.
- Lee L, Ito T, Jensen RT. Imaging of pancreatic neuroendocrine tumors: recent advances, current status and controversies. Expert Rev Anticancer Ther. 2018;18:837-60.
Öz
Kaynakça
- Fascetti-Leon F, Scotton G, Pio L, et al. Minimally invasive resection of adrenal masses in infants and children: results of a European multi-center survey. Surg Endosc. 2017;31:4505-12. Erratum in: Surg Endosc. 2017;31:4513.
- Lenert JT, Barnett CC Jr, Kudelka AP, et al. Evaluation and surgical resection of adrenal masses in patients with a history of extra-adrenal malignancy. Surgery. 2001;130:1060-7.
- Economopoulos KP, Mylonas KS, Stamou AA, et al. Laparoscopic versus robotic adrenalectomy: a comprehensive meta-analysis. Int J Surg. 2017;38:95-104.
- Terzolo M, Ali A, Osella G, Mazza E. Prevalence of adrenal carcinoma among incidentally discovered adrenal masses. Arch Surg. 1997;132:914-9.
- Lucchi M, Dini P, Ambrogi MC, et al. Metachronous adrenal masses in resected non-small cell lung cancer patients: therapeutic implications of laparoscopic adrenalectomy. Eur J Cardiothorac Surg. 2005;27:753-6.
- Uttinger KL, Reibetanz J, Diers J, et al. Volume-outcome relationship in adrenal surgery from 2009-2017 in Germany—a retrospective study. Eur J Endocrinol. 2023;188:lvac013.
- Yan H, Cao G, Cui X, et al. Retroperitoneoscopic enucleation adrenalectomy: a viable surgical option for small nonsecreting adrenal tumors with low potential of malignancy. Transl Androl Urol. 2023;12:1713-22.
- Tzelves L, Juliebø-Jones P, Somani B. Editorial: the evolution of minimally invasive urologic surgery: innovations, challenges, and opportunities. Front Surg. 2024;11:1525713.
- Peng L, Liang R, Zhao A, et al. Amplifying Chinese physicians' emphasis on patients' psychological states beyond urologic diagnoses with ChatGPT - a multicenter cross-sectional study. Int J Surg. 2024;110:6501-8.
- Bancos I, Prete A. Approach to the patient with adrenal incidentaloma. J Clin Endocrinol Metab. 2021;106:3331-53.
- Okroj D, Rzepecka A, Kłosowski P, et al. Review of diagnostic modalities for adrenal incidentaloma. J Clin Med. 2023;12:3739.
- Lee JM, Kim MK, Ko SH, et al. Clinical Guidelines for the Management of Adrenal Incidentaloma. Endocrinol Metab (Seoul). 2017;32:200-18.
- Fu SQ, Zhuang CS, Yang XR, et al. Comparison of robot-assisted retroperitoneal laparoscopic adrenalectomy versus retroperitoneal laparoscopic adrenalectomy for large pheochromocytoma: a single-centre retrospective study. BMC Surg. 2020;20:227.
- Danwang C, Agbor VN, Bigna JJ. Obesity and postoperative outcomes of the patients with laparoscopic adrenalectomy: a systematic review and meta-analysis. BMC Surg. 2020;20:194.
- Davey MG, Ryan ÉJ, Donlon NE, et al. Comparing surgical outcomes of approaches to adrenalectomy - a systematic review and network meta-analysis of randomised clinical trials. Langenbecks Arch Surg. 2023;408:180.
- Wang J, Yang B, Sun S, Zhang Y. Perioperative factors influencing the difficulty of retroperitoneal laparoscopic adrenalectomy: a single-center retrospective study. BMC Urol. 2022;22:22.
- Samsel R, Cichocki A, Roszkowska-Purska K, et al. Adrenal metastases - long-term results of surgical treatment, single-centre experience. Contemp Oncol (Pozn). 2020;24:29-33.
- Sabet FA, Majdzadeh R, Mostafazadeh Davani B, et al. Likelihood ratio of computed tomography characteristics for diagnosis of malignancy in adrenal incidentaloma: systematic review and meta-analysis. J Diabetes Metab Disord. 2016;15:12.
- Aydin H, Dural AC, Sahbaz NA, et al. Hormonally active adrenal tumors; challenges and outcomes for different surgical approaches. Sisli Etfal Hastan Tip Bul. 2021;55:325-32.
- Indrawan DH, Prapiska FF, Warli SM et al. Functional and non-functional types of adrenal tumors: a case series [version 1; peer review: 1 approved with reservations, 1 not approved]. F1000Research. 2021;10:675.
- Herrera-Martínez AD, Rebollo Román Á, Pascual Corrales E, et al. Adrenal incidentalomas and other endocrine-related adenomas: how much does cortisol secretion matter?. Cancers (Basel). 2023;15:4735.
- Parente A, Kamarajah SK, Thompson JP, et al. Risk factors for postoperative complications after adrenalectomy for phaeochromocytoma: multicentre cohort study. BJS Open. 2023;7:zrad090.
- Vlk E, Ebbehoj A, Donskov F, et al. Outcome and prognosis after adrenal metastasectomy: nationwide study. BJS Open. 2022;6:zrac047.
- Dages KN, Kohlenberg JD, Young WF Jr, et al. Presentation and outcomes of adrenal ganglioneuromas: a cohort study and a systematic review of literature. Clin Endocrinol (Oxf). 2021;95:47-57.
- Thompson LH, Ranstam J, Almquist M, et al. Impact of adrenalectomy on morbidity in patients with non-functioning adrenal cortical tumors, mild hypercortisolism and Cushing’s syndrome as assessed by national and quality registries. World J Surg. 2021;45:3099-107.
- Lee L, Ito T, Jensen RT. Imaging of pancreatic neuroendocrine tumors: recent advances, current status and controversies. Expert Rev Anticancer Ther. 2018;18:837-60.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Genel Cerrahi |
| Bölüm | Özgün Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 9 Mayıs 2025 |
| Gönderilme Tarihi | 26 Ocak 2025 |
| Kabul Tarihi | 25 Şubat 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 7 Sayı: 2 |
Chief Editors
Assoc. Prof. Zülal Öner
İzmir Bakırçay University, Department of Anatomy, İzmir, Türkiye
Assoc. Prof. Deniz Şenol
Düzce University, Department of Anatomy, Düzce, Türkiye
Editors
Assoc. Prof. Serkan Öner
İzmir Bakırçay University, Department of Radiology, İzmir, Türkiye
E-mail: medrecsjournal@gmail.com
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