Surgical management of large adrenal tumours: the University of Miami experience using liver transplantation techniques.

OBJECTIVE

To report our experience in the surgical management of patients with large adrenal masses and describe the key steps in performing radical resections, which are especially demanding where thrombi extend into the inferior vena cava (IVC).

PATIENTS AND METHODS

From 2003 to 2007, 14 patients presented with large adrenal mass, and underwent surgical extirpation. In five patients thrombi extended into the IVC, causing Budd-Chiari syndrome in one.

RESULTS

The median (range) patient age was 48 (40-58) years. The excision was radical with negative tumour margins in all cases. Cardiopulmonary bypass (CPB) was required in one case with adherent intra-atrial thrombus. The mean blood loss was 500 (250-1500) mL except in the patient who required CPB. Morbidity included pleural effusion (three patients) and postoperative pneumonia (two), which responded to conservative management. All patients were alive and free of disease at a median follow-up of 12 (5-42) months.

CONCLUSIONS

Surgical extirpation of large adrenal masses requires technical experience to optimize outcome. Total tumour excision is the only therapeutic option in such cases and provides acceptable results in survival and quality of life.