Abordaje laparoscópico en el tratamiento de las tumoraciones adrenales malignas / Laparoscopic approach in the treatment of malignant adrenal tumours

Introducción Los tumores suprarrenales malignos son infrecuentes. La cirugía es el tratamiento que ofrece mejores resultados. Aunque existe controversia al respecto, la creciente experiencia en cirugía laparoscópica permitió la indicación de suprarrenalectomías laparoscópicas en tumores primarios potencialmente malignos y metastásicos. Nuestro objetivo es evaluar la factibilidad técnica de la suprarrenalectomía laparoscópica en neoplasias malignas y describir los resultados de nuestra serie consecutiva de pacientes. Material y métodos Se analizaron retrospectivamente 13 pacientes (10 varones y 3 mujeres) operados por neoplasias suprarrenales primarias y secundarias por vía laparoscópica entre marzo de 1999 y junio de 2009 en el Hospital de Clínicas de la Universidad de Buenos Aires y en el Hospital Alemán de Buenos Aires. El abordaje transperitoneal se utilizó en todos los casos. El seguimiento promedio fue de 37,9 meses (2–84).Resultados Se operaron 13 pacientes que tenían neoplasias malignas suprarrenales por vía laparoscópica. La edad promedio fue de 55,2+12 años, con una relación hombre/mujer de 10/3. Cinco pacientes presentaron carcinomas corticosuprarrenales, uno presentó feocromocitoma maligno y 7 presentaron tumores metastásicos. Tres pacientes requirieron conversión a cirugía abierta. El tiempo operatorio promedio fue de 146,4min. Se presentaron 2 complicaciones postoperatorias. No hubo mortalidad perioperatoria en la serie. La estadía hospitalaria promedio fue de 4,6 días (1–35). La sobrevida actuarial a 3 años fue del 46%. La causa de muerte en todos los casos fue la enfermedad de base. Conclusiones El abordaje laparoscópico es razonable para los tumores suprarrenales malignos cuando se puede reproducir la técnica oncológica realizada por vía abierta (AU)

Background Malignant primary or secondary adrenal tumours are uncommon. For most of them early surgery with adrenalectomy is the only means of cure. Although controversy exists on this issue, the increasing experience in laparoscopic surgery extends the indication for laparoscopic adrenalectomy to potentially malignant and to metastatic adrenal tumours. Our aim was to evaluate the technical feasibility of laparoscopic adrenalectomy for malignant neoplasias, describing the results of our consecutive series of patients. Material and methods We retrospectively analysed 13 patients who underwent laparoscopic adrenalectomy for malignant neoplasia between March 1999 and June 2009, at the Hospital de Clínicas of the Universidad of Buenos Aires and at the Hospital Alemán of Buenos Aires. A transperitoneal laparoscopic approach was used in all patients. The mean follow up was 37.9 months (2–84).Results Thirteen laparoscopic adrenalectomies were performed due to malignant neoplasia. Mean age was 55.2+12 years. The relationship between male and female was 10/3. Five patients had an adrenal carcinoma, 1 patient a malignant phaeochromocytoma, and 7 patients had metastatic tumours. Three patients required conversion to laparotomy. Average operation time was 146.4 min. There were two perioperative complications and no mortality. Average length of hospital stay was 4.6 days (1–35). The survival at 3 years was 46%. The cause of death was the underlying disease in all cases. Conclusion Laparoscopic adrenalectomy is a reasonable technique for malignant adrenal tumours, when the open oncological resection can be reproduced by the laparoscopic approach (AU)

[Laparoscopic approach in the treatment of malignant adrenal tumours]. / Abordaje laparoscópico en el tratamiento de las tumoraciones adrenales malignas.

BACKGROUND: Malignant primary or secondary adrenal tumours are uncommon. For most of them early surgery with adrenalectomy is the only means of cure. Although controversy exists on this issue, the increasing experience in laparoscopic surgery extends the indication for laparoscopic adrenalectomy to potentially malignant and to metastatic adrenal tumours. Our aim was to evaluate the technical feasibility of laparoscopic adrenalectomy for malignant neoplasias, describing the results of our consecutive series of patients. MATERIAL AND METHODS: We retrospectively analysed 13 patients who underwent laparoscopic adrenalectomy for malignant neoplasia between March 1999 and June 2009, at the Hospital de Clínicas of the Universidad of Buenos Aires and at the Hospital Alemán of Buenos Aires. A transperitoneal laparoscopic approach was used in all patients. The mean follow up was 37.9 months (2-84). RESULTS: Thirteen laparoscopic adrenalectomies were performed due to malignant neoplasia. Mean age was 55.2+12 years. The relationship between male and female was 10/3. Five patients had an adrenal carcinoma, 1 patient a malignant phaeochromocytoma, and 7 patients had metastatic tumours. Three patients required conversion to laparotomy. Average operation time was 146.4 min. There were two perioperative complications and no mortality. Average length of hospital stay was 4.6 days (1-35). The survival at 3 years was 46%. The cause of death was the underlying disease in all cases. CONCLUSION: Laparoscopic adrenalectomy is a reasonable technique for malignant adrenal tumours, when the open oncological resection can be reproduced by the laparoscopic approach.