Moinzadeh Alireza, Gill Inderbir S
Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Urol. 2005 Feb;173(2):519-25. doi: 10.1097/01.ju.0000149038.89467.30.
Laparoscopic adrenalectomy for malignancy is controversial. We analyzed our experience with laparoscopic radical adrenalectomy for cancer with an emphasis on predictors of surgical outcome and oncological followup data.
Since July 1997, 31 patients have undergone a total of 33 laparoscopic adrenalectomies for malignancy. Mean adrenal tumor size was 5 cm (range 1.8 to 9). The laparoscopic approach was transperitoneal in 17 cases, retroperitoneal in 15 and transthoracic in 1. Data were obtained from patient charts, radiographic reports and direct telephone calls to patient families.
Associated organ resection (radical nephrectomy) was performed in 3 patients. One case was electively converted to open surgery. There was no operative mortality. The pathological diagnoses were metastatic cancer in 26 cases and primary adrenal malignancy in 7. Current median followup, available on 30 patients, was 26 months (range 1 to 69). Overall 15 patients (48%) died and 16 (52%) were alive, of whom 13 (42%) showed no evidence of disease. Cancer specific survival at a median followup of 42 months was 53% and 5-year actuarial survival was 40%. Local recurrence was noted in 7 patients (23%). There were no port site metastases. Survival was similar in patients with tumors less than 5 cm vs 5 cm or greater. Survival was not associated with patient age, tumor size, operative time or surgical approach. Survival was compromised in patients with local recurrence (p = 0.016).
Laparoscopic radical adrenalectomy can be performed with acceptable outcomes in the carefully selected patient with a small, organ confined, solitary adrenal metastasis or primary adrenal carcinoma. To our knowledge the largest series in the literature to date is presented.
腹腔镜肾上腺切除术治疗肾上腺恶性肿瘤存在争议。我们分析了腹腔镜根治性肾上腺切除术治疗肾上腺恶性肿瘤的经验，重点关注手术结果的预测因素和肿瘤学随访数据。
自1997年7月以来，31例患者共接受了33次腹腔镜肾上腺恶性肿瘤切除术。肾上腺肿瘤平均大小为5厘米（范围1.8至9厘米）。17例采用经腹腹腔镜入路，15例采用后腹腔镜入路，1例采用经胸入路。数据来自患者病历、影像学报告以及直接致电患者家属。
3例患者进行了联合器官切除（根治性肾切除术）。1例患者选择性转为开放手术。无手术死亡病例。病理诊断为转移性癌26例，原发性肾上腺恶性肿瘤7例。目前对30例患者的中位随访时间为26个月（范围1至69个月）。总体上，15例患者（48%）死亡，16例（52%）存活，其中13例（42%）无疾病证据。中位随访42个月时的癌症特异性生存率为53%，5年精算生存率为40%。7例患者（23%）出现局部复发。无切口转移。肿瘤小于5厘米与5厘米及以上的患者生存率相似。生存率与患者年龄、肿瘤大小、手术时间或手术入路无关。局部复发患者的生存率受到影响（p = 0.016）。
对于精心挑选的、肿瘤较小、局限于器官、孤立性肾上腺转移瘤或原发性肾上腺癌患者，腹腔镜根治性肾上腺切除术可取得可接受的结果。据我们所知，本文呈现了迄今为止文献中最大的病例系列。
