McCauley Lipika R, Nguyen Mike M
The University of Arizona, Arizona Health Sciences Center, Tucson, Arizona, USA.
Curr Opin Urol. 2008 Mar;18(2):134-8. doi: 10.1097/MOU.0b013e3282f3e6d2.
Laparoscopic adrenalectomy for malignant adrenal masses has been controversial because of initial reports of high rates of local recurrence and carcinomatosis. With additional experience, improved outcomes have been reported. We evaluate the contemporary role of laparoscopy in treating adrenal malignancies.
Several contemporary reports now demonstrate that laparoscopic adrenalectomy for primary adrenal malignancy can provide oncologic outcomes equivalent to open surgery without an increased risk of carcinomatosis or port site recurrence. Although long-term survival of 47 months with no recurrence has been reported, the underlying aggressiveness of this tumor has contributed to a 39.6% rate of recurrence for the 48 contemporary cases reviewed in this article. This compares favorably to open series that report a similar or higher recurrence rate. When utilized for the treatment of solitary metastases to the adrenal gland, laparoscopic adrenalectomy provides equivalent oncologic outcomes to open adrenalectomy.
Laparoscopic adrenalectomy for malignancy can be performed in appropriately selected cases with equal oncologic outcomes to open approaches while providing advantages in patient morbidity. Caution must be taken to avoid tumor entry or spillage because of the potential for local recurrence, port site recurrence, and carcinomatosis that can occur with these aggressive tumors.
由于最初有报道称腹腔镜肾上腺切除术治疗肾上腺恶性肿瘤的局部复发和癌转移率较高，因此该手术一直存在争议。随着经验的增加，已有改善的治疗结果报道。我们评估腹腔镜手术在治疗肾上腺恶性肿瘤中的当代作用。
目前一些当代研究表明，腹腔镜肾上腺切除术治疗原发性肾上腺恶性肿瘤可获得与开放手术相当的肿瘤学疗效，且癌转移或切口部位复发风险并未增加。尽管有报道称长期生存率达47个月且无复发，但该肿瘤的潜在侵袭性导致本文所回顾的48例当代病例的复发率为39.6%。与报道的复发率相似或更高的开放手术系列相比，这一结果较为有利。当用于治疗肾上腺孤立性转移瘤时，腹腔镜肾上腺切除术与开放肾上腺切除术的肿瘤学疗效相当。
对于经过适当选择的病例，腹腔镜肾上腺切除术治疗恶性肿瘤可获得与开放手术相当的肿瘤学疗效，同时对患者的发病率有优势。由于这些侵袭性肿瘤可能发生局部复发、切口部位复发和癌转移，必须注意避免肿瘤破裂或溢出。
