open access

Vol 71, No 6 (2020)
Original paper
Published online: 2020-10-28
Submitted: 2020-06-05
Accepted: 2020-09-10
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Laparoscopic cortical-sparing adrenal surgery in pheochromocytomas associated with hereditary neoplasia syndromes

Kornelia Hasse-Lazar, Marcin Zeman, Agnieszka Kotecka-Blicharz, Marta Legutko, Agnieszka Czarniecka, Barbara Michalik, Aleksandra Król, Piotr Szymański, Agnieszka Pawlaczek, Małgorzata Oczko-Wojciechowska, Maciej Grajek, Tomasz Gawlik, Daria Handkiewicz-Junak, Barbara Jarząb
DOI: 10.5603/EP.a2020.0075
·
Pubmed: 33125693
·
Endokrynologia Polska 2020;71(6):518-523.

open access

Vol 71, No 6 (2020)
Original Paper
Published online: 2020-10-28
Submitted: 2020-06-05
Accepted: 2020-09-10

Abstract

Introduction: Pheochromocytomas in hereditary syndromes tend to grow multifocal with adrenal involvement on both sides. Surgical treatment with bilateral adrenalectomy inevitably leads to life-long hormonal dependence, which significantly affects quality of life. The development of minimally invasive adrenal surgery has created a chance to preserve adrenal cortex function in these patients. The aim of the present study was to evaluate the safety of laparoscopic cortical-sparing adrenal surgeries and their efficacy in the prevention of postoperative adrenal insufficiency in patients with hereditary pheochromocytomas.

Material and methods: We retrospectively analysed the medical histories of 10 patients, who underwent 10 laparoscopic cortical sparing adrenal surgeries from January 2015 to January 2019 in our centre. The decision to perform sparing surgery was based on preoperative diagnosis of hereditary syndrome in line with the result of DNA analysis or its diagnosis based on the clinical appearance. All surgeries were performed laparoscopically from transperitoneal access in the lateral decubitus position, with preserving 1/3–1/4 adrenal tissue. The sufficiency of remnant adrenal tissue was assessed in all patients. The median time of follow-up was three years (ranged 0.5–4 years).

Results: No intraoperative complications were observed. One case of acute heart failure was the only early postoperative adverse event. There were no late postoperative complications and no local recurrences observed. In one out of three patients undergoing sparing surgery as a second procedure after former total adrenalectomy, adrenal cortex failure occurred. In all patients after unilateral surgery or after bilateral surgery performed simultaneously (total adrenalectomy at one side and sparing surgery contralaterally), function of remnant adrenal tissue was preserved.

Conclusions: In hereditary pheochromocytomas, with minimal risk of malignant process, laparoscopic cortical sparing adrenal surgeries are the safe approach and provide the chance to preserve adrenal cortex function. 

Abstract

Introduction: Pheochromocytomas in hereditary syndromes tend to grow multifocal with adrenal involvement on both sides. Surgical treatment with bilateral adrenalectomy inevitably leads to life-long hormonal dependence, which significantly affects quality of life. The development of minimally invasive adrenal surgery has created a chance to preserve adrenal cortex function in these patients. The aim of the present study was to evaluate the safety of laparoscopic cortical-sparing adrenal surgeries and their efficacy in the prevention of postoperative adrenal insufficiency in patients with hereditary pheochromocytomas.

Material and methods: We retrospectively analysed the medical histories of 10 patients, who underwent 10 laparoscopic cortical sparing adrenal surgeries from January 2015 to January 2019 in our centre. The decision to perform sparing surgery was based on preoperative diagnosis of hereditary syndrome in line with the result of DNA analysis or its diagnosis based on the clinical appearance. All surgeries were performed laparoscopically from transperitoneal access in the lateral decubitus position, with preserving 1/3–1/4 adrenal tissue. The sufficiency of remnant adrenal tissue was assessed in all patients. The median time of follow-up was three years (ranged 0.5–4 years).

Results: No intraoperative complications were observed. One case of acute heart failure was the only early postoperative adverse event. There were no late postoperative complications and no local recurrences observed. In one out of three patients undergoing sparing surgery as a second procedure after former total adrenalectomy, adrenal cortex failure occurred. In all patients after unilateral surgery or after bilateral surgery performed simultaneously (total adrenalectomy at one side and sparing surgery contralaterally), function of remnant adrenal tissue was preserved.

Conclusions: In hereditary pheochromocytomas, with minimal risk of malignant process, laparoscopic cortical sparing adrenal surgeries are the safe approach and provide the chance to preserve adrenal cortex function. 

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Keywords

pheochromocytoma; adrenal sparing surgery; adrenal insufficiency

About this article
Title

Laparoscopic cortical-sparing adrenal surgery in pheochromocytomas associated with hereditary neoplasia syndromes

Journal

Endokrynologia Polska

Issue

Vol 71, No 6 (2020)

Article type

Original paper

Pages

518-523

Published online

2020-10-28

DOI

10.5603/EP.a2020.0075

Pubmed

33125693

Bibliographic record

Endokrynologia Polska 2020;71(6):518-523.

Keywords

pheochromocytoma
adrenal sparing surgery
adrenal insufficiency

Authors

Kornelia Hasse-Lazar
Marcin Zeman
Agnieszka Kotecka-Blicharz
Marta Legutko
Agnieszka Czarniecka
Barbara Michalik
Aleksandra Król
Piotr Szymański
Agnieszka Pawlaczek
Małgorzata Oczko-Wojciechowska
Maciej Grajek
Tomasz Gawlik
Daria Handkiewicz-Junak
Barbara Jarząb

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