Session: MON 1-36-Adrenal Incidentaloma & Carcinoma
Poster Board MON-16
U. Maestroni1, D. Vicente2, P. Del Rio1, F. Ziglioli1, F. Dinale1, D. Campobasso1, S. Ferretti1, A. Stojadinovic,3,4, I. Avital5
1 Department of Surgery -University Hospital of Parma
2 Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD
3 United States Military Cancer Institute, Bethesda, MD
4 Uniformed Services University of the Health Sciences, Bethesda, MD
5 Bon Secours Cancer Institute, Richmond, VA
BACKGROUND: The incidence of adrenal incidentaloma (>1 cm) on radiological imaging is ~5%, while the incidence reported in autopsy series is ~9%. Laparoscopic adrenalectomy is generally recommended for benign masses and pheochromocytoma. For many years laparoscopic adrenalectomy was not indicated for adrenal masses >4 cm, as risk of malignancy exceeds 25% in masses ≥6 cm, and risk of laparoscopic resection increases with tumor size. Our prospective series compares laparoscopic adrenalectomy for both small with large-sized tumors.
METHODS: Outcomes [OR and hospital time; operative blood loss(EBL); 30-day morbidity; re-operation] were compared by tumor size (< vs. ≥ 4cm) for consecutive laparoscopic adrenalectomies performed from 2009 to 2012 (n=77).
RESULTS: Fifty and 27 patients had tumors <4 and ≥ 4cm, respectively. In the ≥ 4cm group, 10 tumors were >6cm in size (largest=14cm). Mean OR time varied by size and laterality: <4cm, right vs. left: 130 vs. 102 minutes; ≥4cm, right vs. left: 135 vs. 116 minutes. Mean EBL for tumors <4 and ≥ 4cm was 30 and 50 ml, respectively. Two(2.6%) cases were converted to open adrenalectomy. Morbidity(5.2%) included pneumothorax (n=2) and post-operative bleeding (n=2). All patients were discharged home on post-operative day 3; there were no re-operations. Pathology by size was: <4cm, adenoma, pheochromocytoma, neuroblastoma, metastasis; ≥4cm, adenoma, pheochromocytoma, myelolipoma, adrenocortical carcinoma, metastasis.
CONCLUSION: Laparoscopic adrenalectomy is safe and effective in incidental tumors ≥4cm. Size of incidentaloma is not a contraindication to the laparoscopic approach. The only absolute contraindication is involvement of surrounding structures that can be readily ascertained by cross-sectional imaging.
Nothing to Disclose: DV, UM, PD, FZ, FD, DC, SF, AS, IA
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