Laparoscopic surgery for adrenal tumors (results from 450 operations) | Γιώργος Ζωγράφος - Ιατρός Χειρουργός
1. LAPAROSCOPIC SURGERY FOR ADRENAL
TUMORS: results from 450 operations
C. Aggeli, A. Nixon, I. Perysinakis,
A. Diamantopoulos, A. Koronaios, G.N. Zografos
Department of Surgery
Athens General Hospital ‘ G. Gennimatas’, Greece
EAES CONGRESS, AMSTERDAM JUNE 16-18, 2016
2. ADRENAL SURGERY
Third Department of Surgery, Athens General Hospital
“G. Gennimatas”
January 1998 – December 2015
450 Resection of adrenal tumors ( 439 patients)
361 Laparoscopic procedure
50 Open approach from the start
37 Conversion of laparoscopic approach to open
13. LARGE ADRENAL TUMORS
• 121/450( 8 to 23 cm)
• 71 tumors 8 – 14 cm
laparoscopically
• Tumors > 15cm can not be
resected laparoscopically
• 3 Hand – assisted
technique
Bresadola V et al Applicability of laparoscopic approach to the resection of large adrenal tumors:
a retrospective cohort study of 200 patients Surg Endosc 2015; 5
Zografos GN et al. Laparoscopic resection of large adrenal ganglioneuroma
J Surg Lap Soc 2007;11(4):487-492.
14. LAPAROSCOPIC SURGERY FOR
MALIGNANT AND POTENTIALLY
MALIGNANT TUMORS
• Primary malignancy: 5/23 laparoscopic ( 1 pheo, 4
cortical)
• Potentially malignant: 25 laparoscopic ( 5/6 cortical,
2 paragagglioma, 18/23 pheochromocytoma)
• Solitary adrenal metastasis: 7 laparoscopic, 5
conversion, 6 open from the start
15. 37 CONVERSION TO OPEN
• 12 Malignant tumors ( oncologic safety),
• 9 large tumors
• 16 previous surgery, in learning curve
16. ADRENAL SPARING SURGERY
• Bilateral benign
pheochromocytoma in
ΜΕΝ ΙΙ ( 4 cases)
• Conn’ s syndrome (5/66)
17. Adrenal mass
CT, MRI Laboratory screen
Biochemically active Biochemically inactive
<12-14cm >12-14cm <4cm >12-14 cm
Open
Adrenalectomy
Serial CT
<
Open
Adrenalectomy
Lap
Adrenalectomy
>4 cm,<12-14cm
<4cm, <50yo
Laparoscopic
adrenalectomy
Primary Malignancy cautious approach
Possible invasion early conversion
18. CONCLUSION
Laparoscopic surgery is indicated in all benign adrenal
tumors
Large tumors 8-14 cm necessitate laparoscopic experience
Solitary adrenal metastasis can be safely resected
laparoscopically
G. Zografos et al . Laparoscopic adrenalectomy for large adrenal metastasis from
contralateral renal cell carcinoma. J.S.L.S 2007;11(2):261-265
19. CONCLUSIONS
• Primary adrenal tumors suspicious of malignancy < 10 cm
must be approached by laparoscopy in specialized centres.
• Malignant tumors or potentially malignant tumors > 10 cm,
with or without peri-adrenal invasion must be operated by
open technique from the start
Ζografos G.N et al Laparoscopic surgery for malignant adrenal tumors
Journal Surgical Oncology 2009;13(2):196-202
Zografos G.N. et al Laparoscopic surgery for potentially malignant adrenal tumors: an
unresolved issue. Hormones 2015