ADRENAL SURGERY - Third Department of Surgery, Athens General Hospital of “G. Gennimatas” January 1998 – December 2015

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

3. 450 Procedures
January 1998 – December 2015

4. ADRENAL SURGERY
Third Department of Surgery, Athens General Hospital
“G. Gennimatas” January 1998 – December 2015
 121 Adenoma (72 autonomous cortizol+/- aldosterone)
29 Potentially malignant tumors ( 24 medulla, 5 cortical)
63 Cushing’ syndrome
11 Cushing’ disease
65 Pheochromocytoma (5 ectopic, 4 ΜΕΝ ΙΙΑ)
35 Malignant tumors
6 Malignant pheochromocytoma
1 Recurrent malignant pheochromocytoma
13 Metastatic Ca (lung., colon, kidney )
24 Primary cortical Ca
1 Αngiosarcoma
66 Conn’ s syndrome
12 Μyelolipoma
11 Cysts, Cystic tumors

6. •Mean age: 53,6 years

7. PATIENT POSITIONING

9. 65 Pheochromocytomas
Hypervascular tumors, need laparoscopic
experience

10. G.N. Zografos, G. Piaditis et al. Laparoscopic resection of
pheochromocytoma with delayed vein ligation
Surg Laparosc Endosc Percut Tech 2011;21(2):116

11. LAPAROSCOPIC ADRENALECTOMY IN CUSHING’S
SYNDROME ( 63 +11 Cushing’s disease)

12. 72 SUBCLINICAL CUSHING

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