Department of General Surgery, Bnai-Zion Medical Center, 47 Golomb Street, Haifa, Israel.
Surg Endosc. 2013 Jul;27(7):2321-6. doi: 10.1007/s00464-012-2772-8. Epub 2013 Jan 26.
Laparoscopic adrenalectomy (LA) is the treatment of choice for benign adrenal lesions. Size of the lesion and radiologic features define the risk for malignancy. In lesions at high risk of malignancy, the experience with the laparoscopic approach is limited and therefore controversial. The purpose of this study was to determine the feasibility and oncological safety of LA for malignant disease.
Retrospective analysis of prospectively collected database. All LA performed in our department from 2003 to 2011 were reviewed and demographic, perioperative, and follow-up data for those who had malignancy in the final histological report was analyzed. Data are presented as mean ± standard deviation or median (range).
Of 121 LA, we identified 20 patients with 21 malignant adrenal pathologies: 11 primary tumors, 5 adrenocortical carcinoma, 5 large B cell lymphoma, and 1 leiomyosarcoma. Ten metastatic lesions included 5 malignant melanoma (1 patient, both sides), 4 adenocarcinoma, and 1 renal cell carcinoma. There was no conversion to laparotomy. Tumor size was 4.5 (1-9.5) cm, operative duration was 79 (42-262) min, and estimated blood loss was 40 (0-250) ml. All patients resumed regular diet on postoperative day 1, and the median length of stay was 2 days after surgery. Two patients died at 6 and 24 months postoperatively. Three patients were lost to follow-up. All the rest of the patients were disease-free at a follow-up of 58 (7-96) months.
LA for primary or metastatic malignant lesions is feasible and seems oncologically safe. Surgical principles should be the same for all LA: en bloc resection of all epinephric fat, minimal touch technique, and low threshold for conversion. Size of the lesion alone should not be an indication for open surgery.
腹腔镜肾上腺切除术（LA）是治疗良性肾上腺病变的首选方法。病变的大小和影像学特征定义了恶性肿瘤的风险。在恶性肿瘤风险较高的病变中，腹腔镜方法的经验有限，因此存在争议。本研究的目的是确定 LA 治疗恶性疾病的可行性和肿瘤安全性。
回顾性分析前瞻性收集的数据库。对 2003 年至 2011 年在我科进行的所有 LA 进行了回顾性分析，并对最终组织学报告中存在恶性肿瘤的患者的人口统计学、围手术期和随访数据进行了分析。数据以平均值±标准差或中位数（范围）表示。
在 121 例 LA 中，我们发现 20 例患者有 21 例恶性肾上腺病理：11 例原发性肿瘤，5 例肾上腺皮质癌，5 例大 B 细胞淋巴瘤和 1 例平滑肌肉瘤。10 例转移性病变包括 5 例恶性黑色素瘤（1 例患者双侧），4 例腺癌和 1 例肾细胞癌。无中转开腹。肿瘤大小为 4.5（1-9.5）cm，手术时间为 79（42-262）min，估计出血量为 40（0-250）ml。所有患者术后第 1 天恢复常规饮食，术后中位住院时间为 2 天。2 例患者分别在术后 6 个月和 24 个月死亡。3 例患者失访。其余所有患者在随访 58（7-96）个月时均无疾病。
LA 治疗原发性或转移性恶性病变是可行的，且似乎具有肿瘤学安全性。所有 LA 都应遵循相同的手术原则：整块切除所有肾上腺脂肪、最小接触技术和中转的低阈值。仅病变大小不应成为开放手术的指征。
