Comparison of adrenal tumor treatment results by different volume of surgical interventions.

In recent years detection of various adrenal tumors has increased greatly. Total adrenalectomy remains the standart of surgical managment for adrenal tumors, although, the vast majority of these tumors turn out to be benign on the routine histological examination. Performing organ-sparing surgery would allow to avoid hormone insufficiency after total adrenalectomy.

Aim: to compare results of adrenal tumors treatment by different volume of surgical interventions.

Materials and methods. We evaluated the short-term results of 237 patients treatment with various adrenal tumors. Total adrenalectomy were performed on 206 cases, 31 patients undergone adrenal resection. There were analyzed intraoperative and postoperative complications, assessed the hormonal status of the patients, depending on the extent of surgical treatment. Besides, the long-term results were evaluated in 141 patients underwent total adrenalectomy and 30 patients after organ-sparing surgery. Moreover, we analyzed the percentage of recurrenses, assessed the hormonal status of the patients and the effectiveness of treatment.

Results. Performing the organ-sparing operations doesn't increase the risk of intraoperative complications. In all patients with hormone-active tumors we found decline of pathologically increased hormone levels and trend to regress of clinical manifestations of the disease in early postoperative period. We found no difference in local recurrences in both groups, and its occurrence did not exceed 3.33%. Refractory postoperative adrenal insufficiency was observed only in corticosteroma patients in spite of surgery volume. In case of both side adrenal tumors there was no need in replacement therapy after total adrenalectomy from there one side and resection from the other.

Conclusions. In cases of adrenal tumor performing organ-sparing operations is advisable, if there are no preoperative sings of malignancy.

1. Богданов Д.Ю., Матвеев Н.А., Курганов И.А., Садовников С.В. Эндовидеохирургическая адреналэктомия: современное состояние и перспективы развития // Эндоскопическая хирургия. – 2008. – №5. – C. 41–49. [Bogdanov D.Iu., Matveev N.A., Kurganov I.A., Sadovnikov S.V. Endovideosurgical adrenalectomy: present state and perspectives. Ėndoskopicheskaia khirurgiia. 2008;5:41-49. (In Russ.)]

2. Ветшев П.С., Ипполитов Л.И., Ветшев С.П., Коваленко Е.И. Спорные вопросы и негативные тенденции в диагностике и хирургическом лечении случайно выявленных опухолей надпочечников // Хирургия. – 2005. – №6. – С. 11–15. [Vetshev PS, Ippolitov LI, Vetshev SP, Kovalenko EI. Controversial issues and negative tendencies in diagnostics and surgical treatment of incidentally revealed tumors of adrenal glands. Khirurgiia. 2005;6:11-15. (In Russ.)]

3. Котельникова Л.П., Каменева О.С., Дмитриева А.М. Компьютерная томография в дифференциальной диагностике инциденталом надпочечников // Современные проблемы науки и образования. – 2008. – №6. – С. 129–133. [Kotelnikova LP, Kameneva OS, Dmitrieva AM. Computer tomography in differential diagnosis of incidental adrenal tumors. Sovremennye problemy nauki i obrazovaniya. 2008;6:129-133. (In Russ.)]

4. Молашенко Н.В., Юкина М.Ю., Солдатова Т.В., Рогаль Е.А. Объемные образования надпочечников (диагностика и дифференциальная диагностика) // Проблемы эндокринологии. – 2010. – Т. 56. – №1. – C. 48–56. [Molashenko NV, Iukina MI, Soldatova TV, Rogal' EA. Adrenal masses (diagnosis and differential diagnosis). Problems of Endocrinology. 2010;56(1):48-56. (In Russ.)] doi: 10.14341/probl201056148-56.

5. Ничитайло М.Е., Черный В.В., Гулько О.Н., и др. Лапароскопическая резекция надпочечника // Украинский журнал хирургии. – 2013. – №4. – С. 48–51. [Nichitaylo MY, Chorny VV, Gulko ON, et al. Laparoscopic adrenalectomy. Ukrainian journal of surgery. 2013;4:48-51. (In Russ.)]

6. Brunaud L, Kebebew E, Sebag F, et al. Observation or laparoscopic adrenalectomy for adrenal incidentaloma? A surgical decision analysis. Med Sci Monit. 2006;12(9):CR355-362.

7. Castillo OA, Diaz M, Arellano L. Partial laparoscopic adrenalectomy in primary hyperaldosteronism. Actas Urol Esp. 2011;35(2):119-122. doi: 10.1016/j.acuro.2010.11.009.

8. Gupta GN, Benson JS, Ross MJ, et al. Perioperative, functional, and oncologic outcomes of partial adrenalectomy for multiple ipsilateral pheochromocytomas. J Endourol. 2014;28(1):112-116. doi: 10.1089/end.2013.0298.

9. Winter JM, Talamini MA, Stanfield CL, et al. Thirty robotic adrenalectomies: a single institution's experience. Surg Endosc. 2006;20(1):119-124. doi: 10.1007/s00464-005-0082-0.

10. Емельянов С.И., Курганов И.А., Богданов Д.Ю., Матвеев Н.Л. Лапароскопическая резекция надпочечников // Эндоскопическая хирургия. – 2010. – Т. 16. – №3. – С. 11–17. [Emel'ianov SI, Kurganov IA, Bogdanov DI, Matveev NL. Laparoscopic adrenal resection. Ėndoskopicheskaia khirurgiia. 2010;16(3):11-17. (In Russ.)]

11. Белошицкий М.Е., Калинин А.П., Богатырев О.П., и др. Отдаленные результаты хирургического лечения инциденталом надпочечников // Практическая медицина. 2012. №9 (65). [Beloshitky ME, KalininAP, Bogatirev OP, et al. Long-term results of surgical treatment of adrenal insidentalomas. Prakticheskaya meditsina. 2012;9:113-116. (In Russ.)]

12. Латыпов В.Р., Попов О.С., Вусик А.Н., и др. Особенности и результаты хирургического лечения пациентов с опухолями надпочечников // Сибирский онкологический журнал. – 2010. – №1. – С. 56–60.[Latypov VR, Popov OS, Vusik AN, et al. Peculiarities and results of surgical treatment of pathients with adrenal tumours. Sibirskii onkologicheskii zhurnal. 2010;1:56-60. (In Russ.)]

13. Kaye DR, Storey BB, Pacak K, et al. Partial adrenalectomy: underused first line therapy for small adrenal tumors. J Urol. 2010;184(1):18-25. doi: 10.1016/j.juro.2010.03.052.