Adrenalectomy for solid tumor metastases: results of a multicenter European study.

BACKGROUND: We assessed the results of adrenalectomy for solid tumor metastases in 317 patients recruited from 30 European centers. METHODS: Patients with histologically proven adrenal metastatic disease and undergoing complete removal(s) of the affected gland(s) were eligible. RESULTS: Non-small cell lung cancer (NSCLC) was the most frequent tumor type followed by colorectal and renal cell carcinoma. Adrenal metastases were synchronous (≤6 months) in 73 (23%) patients and isolated in 213 (67%). The median disease-free interval was 18.5 months. Laparoscopic resection was used in 46% of patients. Surgery was limited to the adrenal gland in 73% of patients and R0 resection was achieved in 86% of cases. The median overall survival was 29 months (95% confidence interval, 24.69-33.30). The survival rates at 1, 2, 3, and 5 years were 80%, 61%, 42%, and 35%, respectively. Patients with renal cancer showed a median survival of 84 months, patients with NSCLC 26 months, and patients with colorectal cancer 29 months (P = .017). Differences in survival between metachronous and synchronous lesions were also significant (30 vs. 23 months; P = .038). CONCLUSION: Surgical removal of adrenal metastasis is associated with long-term survival in selected patients.

[Implantation of laparoscopic colon surgery in a general surgery department]. / Implantación de la cirugía laparoscópica de colon en un servicio de cirugía general.

OBJECTIVE: To evaluate the viability, safety and short-term results of laparoscopic colon surgery during the first few years after its introduction in our department. METHOD: Between January 2002 and December 2005, laparoscopic surgery was performed in patients with surgical indication for benign colon disease. After 2003, patients with malignant disease were also included. A database was created and demographic data, surgical indication, technique, conversion rate, morbidity and postoperative length of stay were recorded. All patients were operated on by the same team of three surgeons. RESULTS: Ninety consecutive patients, with a mean age of 59.2 years (20-88) underwent laparoscopic surgery. Of these, 53 were men (59%). In total, 32 patients had previously undergone one or more open laparotomies (35.5%). Surgery was indicated for benign disease in 60 patients (66%). Distribution was left colon in 79 patients and right colon in 11 patients. The most frequent technique was sigmoidectomy (67.7%). The conversion rate was 12.2%. Operating time was 199 min. (120-340) and length of postoperative stay was 7.5 days (4-57). Morbidity was 18.8% and mortality was 1.1%. CONCLUSIONS: Laparoscopic surgery of the colon is safe and reproducible. Our short-term results are similar to those of previous studies. We believe that prior experience of laparoscopic surgery is important and that a stable surgical team minimizes the effect of the learning curve.

Implantación de la cirugía laparoscópica de colon en un servicio de cirugía general / Implantation of laparoscopic colon surgery in a general surgery department

Objetivo. El objetivo de este estudio fue documentar la factibilidad, la seguridad y los resultados a corto plazo de la cirugía laparoscópica de colon durante los primeros años de implantación de dicha técnica en nuestro servicio. Método. Entre enero de 2002 y diciembre de 2005, se propuso cirugía laparoscópica a los pacientes con indicación quirúrgica por afección benigna de colon. A partir de 2003, se incluyó también a los pacientes con enfermedad maligna. Se creó una base de datos, actualizada, donde se incluyeron los datos demográficos, la indicación quirúrgica, la técnica, la tasa de conversión, la morbilidad y la estancia postoperatoria. Todos los pacientes fueron intervenidos por un mismo equipo de 3 cirujanos. Resultados. Fueron intervenidos 90 pacientes consecutivos, con media de edad de 59,2 (intervalo, 20-88) años. De ellos, 53 (59%) eran varones. En total, 32 (35,5%) pacientes presentaban una o más laparotomías previas por vía abierta. La indicación fue por causa benigna en 60 (66%) casos. La distribución fue de 79 casos en colon izquierdo y 11 en colon derecho. La técnica más frecuente fue la sigmoidectomía (67,7%). La tasa de conversión fue del 12,2%. El tiempo de intervención, 199 (120-340) min y la estancia postoperatoria, de 7,5 (4-57) días. La morbilidad fue del 18,8% y la mortalidad, del 1,1%. Conclusiones. La cirugía laparoscópica de colon es segura y reproducible. Nuestros resultados a corto plazo son comparables a los resultados históricos publicados. Creemos que la experiencia laparoscópica previa es importante y que un equipo quirúrgico estable minimiza el impacto de la curva de aprendizaje (AU)

Objective. To evaluate the viability, safety and short-term results of laparoscopic colon surgery during the first few years after its introduction in our department. Method. Between January 2002 and December 2005, laparoscopic surgery was performed in patients with surgical indication for benign colon disease. After 2003, patients with malignant disease were also included. A database was created and demographic data, surgical indication, technique, conversion rate, morbidity and postoperative length of stay were recorded. All patients were operated on by the same team of three surgeons. Results. Ninety consecutive patients, with a mean age of 59.2 years (20-88) underwent laparoscopic surgery. Of these, 53 were men (59%). In total, 32 patients had previously undergone one or more open laparotomies (35.5%). Surgery was indicated for benign disease in 60 patients (66%). Distribution was left colon in 79 patients and right colon in 11 patients. The most frequent technique was sigmoidectomy (67.7%). The conversion rate was 12.2%. Operating time was 199 min. (120-340) and length of postoperative stay was 7.5 days (4-57). Morbidity was 18.8% and mortality was 1.1%. Conclusions. Laparoscopic surgery of the colon is safe and reproducible. Our short-term results are similar to those of previous studies. We believe that prior experience of laparoscopic surgery is important and that a stable surgical team minimizes the effect of the learning curve (AU)