Adrenal-preserving surgery of adrenal tumours

Abstract

Currently, laparoscopic adrenalectomy is seen as more than just the preferred method, in fact as a routine procedure, always bearing in mind, however, the developed restraints on its usage. The size of the tumour, recurrent disease, and the existing invasive process all remain factors which determine the indications for operation. The situation is similar in cases of qualifying for sparing (non-radical) operations on adrenal glands. The basic challenge in terms of qualification, choice of technique and the range of operation of adrenal lesions remains: obtaining a reliable preoperative diagnosis, the localisation of lesions including their ectopic location, the evaluation of the imaging phenotype, as well as a proper pre-surgical preparation. Maintaining one third of properly vascularised adrenal mass allows one to avoid a substitutive therapy, with the possible necessity of its application in stressful situations. The first partial adrenalectomy has been conducted on a patient with a bilateral pheochromocytoma, in order to retain the glucocorticoid adrenal functions. The recommendations for its administration remain: hereditary pheochromocytoma of at least 2cm diameter, unilateral adenoma of at least 5cm diameter in Cushing’s syndrome without any concomitant lesions in the oposite adrenal gland, and unilateral adenoma in Conn’s syndrome. It seems that non-radical resection should always be considered for patients at risk of bilateral adrenalectomy in cases of concomitant lesions in both adrenals.