Pędziwiatr Michał, Wierdak Mateusz, Natkaniec Michał, Matłok Maciej, Białas Magdalena, Major Piotr, Budzyński Piotr, Hubalewska-Dydejczyk Alicja, Budzyński Andrzej
2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501, Kraków, Poland.
Department of Physiology, Jagiellonian University, Grzegórzecka 16, 31-531, Kraków, Poland.
BMC Surg. 2015 Aug 28;15:101. doi: 10.1186/s12893-015-0088-z.
Laparoscopic adrenalectomy is still controversial in cases where malignancy is suspected. However, many proponents of this technique argue that in the hands of an experienced surgeon, laparoscopy can be safely performed. The aim of this study is to present our own experience with the application of laparoscopic surgery for the treatment of malignant and potentially malignant adrenal tumours.
Our analysis included 52 patients who underwent laparoscopic adrenalectomy in 2003-2014 due to a malignant or potentially malignant adrenal tumour. Inclusion criteria were primary adrenal malignancy, adrenal metastasis or pheochromocytoma with a PASS score greater than 6. We analyzed the conversion rate, intra- and postoperative complications, intraoperative blood loss and R0 resection rate. Survival was estimated using the Kaplan-Meier method.
Conversion was necessary in 5 (9.7%) cases. Complications occurred in a total of 6 patients (11.5%). R0 resection was achieved in 41 (78.8%) patients and R1 resection in 9 (17.3%) patients. In 2 (3.9%) cases R2 resection was performed. The mean follow-up time was 32.9 months. Survival depended on the type of tumour and was comparable with survival after open adrenalectomy presented in other studies.
We consider that laparoscopic surgery for adrenal malignancy can be an equal alternative to open surgery and in the hand of an experienced surgeon it guarantees the possibility of noninferiority. Additionally, starting a procedure with laparoscopy allows for minimally invasive evaluation of peritoneal cavity. The key element in surgery for any malignancy is not the surgical access itself but the proper technique.
在怀疑为恶性的病例中，腹腔镜肾上腺切除术仍存在争议。然而，该技术的许多支持者认为，在经验丰富的外科医生手中，腹腔镜手术可以安全实施。本研究的目的是介绍我们应用腹腔镜手术治疗恶性及潜在恶性肾上腺肿瘤的经验。
我们的分析纳入了2003年至2014年间因恶性或潜在恶性肾上腺肿瘤接受腹腔镜肾上腺切除术的52例患者。纳入标准为原发性肾上腺恶性肿瘤、肾上腺转移瘤或PASS评分大于6的嗜铬细胞瘤。我们分析了中转率、术中和术后并发症、术中失血量及R0切除率。采用Kaplan-Meier法估计生存率。
5例（9.7%）需要中转手术。共有6例患者（11.5%）发生并发症。41例（78.8%）患者实现了R0切除，9例（17.3%）患者实现了R1切除。2例（3.9%）进行了R2切除。平均随访时间为32.9个月。生存率取决于肿瘤类型，与其他研究中开放性肾上腺切除术后的生存率相当。
我们认为，腹腔镜手术治疗肾上腺恶性肿瘤可以成为开放性手术的同等替代方案，在经验丰富的外科医生手中，它保证了不劣于开放性手术的可能性。此外，以腹腔镜手术开始操作可对腹腔进行微创评估。任何恶性肿瘤手术的关键要素不是手术入路本身，而是正确的技术。
