Department of General, Visceral, Cancer and Transplant Surgery, University Hospital Cologne, Cologne, Germany.
Department of Radiology, University Hospital Cologne, Cologne, Germany.
Horm Metab Res. 2022 May;54(5):294-299. doi: 10.1055/a-1808-7239. Epub 2022 May 9.
Work up of adrenal masses includes assessment of endocrine activity and malignancy risk. There is no indication for surgical removal of nonfunctional adrenal adenomas, according to the guidelines. In the present study, we aimed at evaluating the impact of a university endocrine tumor board on the quality of the indications for adrenal surgery at our institution. One hundred consecutive patients receiving primary adrenal surgery at the University Hospital of Cologne, Germany were included. Their demographics, clinic-pathologic characteristics, treatment and outcome were analyzed. In 55 (55%) cases, indication for surgery consisted in functional benign tumors, including Conn, Cushing adenomas and pheochromocytomas. Forty (40%) tumors were referred to surgery for malignancy suspicion and 5 (5%) myelolipomas were removed due to their size. Eighty-nine percent of surgeries were performed as minimally invasive procedures. Overall morbidity included two (2%) self-limiting pancreatic fistulas after left laparoscopic adrenalectomy for pheochromocytoma. All functional tumors were confirmed benign by final histology. Only 33 (82.5%) of 40 suspicious cases turned out to be malignant. Consequently, nonfunctional benign adenomas were "unnecessarily" removed in only 7 (7%) patients, with 6 (85.7%) of them having a history of extra-adrenal cancer and all of them fulfilling criteria for surgery, according to the international guidelines. In conclusion, the endocrine tumor board provided an excellent adherence to the guidelines with most surgeries being performed either for functional or malignant tumors. In nonfunctional tumors with history of extra adrenal cancer, CT guided biopsy might be considered for obviating surgery.
肾上腺肿块的评估包括内分泌活性和恶性风险的评估。根据指南，无功能肾上腺腺瘤无需手术切除。在本研究中，我们旨在评估大学内分泌肿瘤委员会对我们机构肾上腺手术指征质量的影响。纳入了德国科隆大学医院接受原发性肾上腺手术的 100 例连续患者。分析了他们的人口统计学、临床病理特征、治疗和结果。在 55 例（55%）病例中，手术指征为功能性良性肿瘤，包括 Conn、库欣腺瘤和嗜铬细胞瘤。40 例（40%）肿瘤因怀疑恶性而转至手术治疗，5 例（5%）因肿瘤过大而切除骨髓脂肪瘤。89%的手术为微创。总发病率包括 2 例（2%）在左侧腹腔镜肾上腺嗜铬细胞瘤切除术后发生的自限性胰瘘。所有功能性肿瘤最终组织学均证实为良性。仅 40 例可疑病例中的 33 例（82.5%）为恶性。因此，仅有 7 例（7%）无功能良性腺瘤被“不必要”切除，其中 6 例（85.7%）有肾上腺外癌症史，且根据国际指南，所有患者均符合手术标准。总之，内分泌肿瘤委员会严格遵循指南，大多数手术是为功能性或恶性肿瘤进行的。对于有肾上腺外癌症史的无功能性肿瘤，可考虑进行 CT 引导下活检以避免手术。
