Ciancio Gaetano, Farag Ahmed, Gonzalez Javier, Gaynor Jeffrey J
Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA; Department of Urology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA; Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.
Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA; Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA; Department of Surgery, Zagazig University School of Medicine, Zagazig, Egypt.
Surg Oncol. 2021 Jun;37:101544. doi: 10.1016/j.suronc.2021.101544. Epub 2021 Mar 19.
Adrenal tumors with/out tumor thrombus (TT) in the inferior vena cava (IVC) pose a challenge to the surgeon due to the potential of massive hemorrhage and tumor thromboembolism. We report our experience in managing different types of adrenal tumors.
From 11/1996-5/2015, 33 patients underwent resection of adrenal tumors with/without TT/IVC in 8 and 25 patients, respectively. Transplant-based (TB) techniques were utilized to resect the tumors. Intra-operative as estimated blood loss (EBL) and cardiopulmonary bypass (CPB) use; post-operative as length of hospital stay (LOS); and actuarial survival outcomes were recorded.
Median EBL was 200 cc (10-8,000), tumor size was 9.0 cm (4-25), and LOS was 7days (5-60). Adrenocortical carcinoma (ACC,11/33) was the commonest type. Three ACC/level IV TT/IVC underwent CPB to extract TT from the right atrium(n = 1), right atrium and right ventricle(n = 1), and right atrium and right pulmonary artery(n = 1), respectively. A complete resection of the adrenal tumors was achieved in all patients, and no deaths were observed in the immediate postoperative period. With a median follow-up of 60 (range: 18-120) months, 4/11 ACC patients have died of their disease. Actuarial survival for ACC patients at 60 months was 57.1 ± 16.4%.
An aggressive surgical approach is the only hope for curing large adrenal tumors with/without TT/IVC. TB techniques provide excellent exposure to the retroperitoneal space and safe removal of large adrenal masses.
肾上腺肿瘤伴或不伴下腔静脉（IVC）瘤栓（TT），因存在大出血和肿瘤血栓栓塞的风险，给外科医生带来了挑战。我们报告了我们处理不同类型肾上腺肿瘤的经验。
从1996年11月至2015年5月，33例患者接受了肾上腺肿瘤切除术，其中8例伴有TT/IVC，25例不伴有TT/IVC。采用基于移植的（TB）技术切除肿瘤。记录术中估计失血量（EBL）和体外循环（CPB）的使用情况；术后记录住院时间（LOS）；并记录精算生存结果。
中位EBL为200 cc（10 - 8000），肿瘤大小为9.0 cm（4 - 25），LOS为7天（5 - 60）。肾上腺皮质癌（ACC，11/33）是最常见的类型。3例ACC/IV级TT/IVC患者分别接受CPB，从右心房（n = 1）、右心房和右心室（n = 1）、右心房和右肺动脉（n = 1）取出TT。所有患者均实现了肾上腺肿瘤的完全切除，术后即刻无死亡病例。中位随访60（范围：18 - 120）个月，11例ACC患者中有4例死于疾病。ACC患者60个月的精算生存率为57.1±16.4%。
积极的手术方法是治愈伴或不伴TT/IVC的大型肾上腺肿瘤的唯一希望。TB技术能很好地暴露腹膜后间隙并安全切除大型肾上腺肿块。
