Victoria M Gershuni, MS, James G Bittner Iv, MD, Jeffrey F Moley, MD, Mary Quasebarth, RN, L Michael Brunt, MD. Sections of Minimally Invasive Surgery and Endocrine and Oncologic Surgery, Department of Surgery, Washington University School of Medicine
Introduction: Adrenal myelolipoma (AM), comprised of fat and bone marrow elements, is a benign adrenal lesion for which adrenalectomy is infrequently indicated. The purpose of this study was to review operative indications and perioperative outcomes for AM in a large single institution series of adrenalectomies.
Methods: A prospective registry of patients who underwent adrenalectomy for any indication at a single high-volume teaching hospital from 1993 through 2010 was reviewed retrospectively. Patients who underwent laparoscopic adrenalectomy (LA) for AM or other adrenal pathology were compared for differences in characteristics, operative indications, perioperative outcomes, and morbidity using nonparametric tests (α=.05). Data are presented as proportions or mean with standard deviation.
Results: In total, 422 adrenalectomies were performed in 402 patients, of whom 16 (4%) patients had AM confirmed on final pathology. Fourteen patients with preoperatively suspected AM subsequently underwent operation, of whom 13 (93%) had AM and 1 had an adrenal hematoma confirmed on pathology. Of 14 patients who underwent operation for AM, 5 (36%) had multiple indications including abdominal or flank pain (n=6), tumor diameter >8 cm (n=8), atypical radiologic appearance (n=4), and/or inferior vena cava compression (n=1). In this group, 13 (93%) underwent LA and 1 had an open adrenalectomy (OA) due to prior abdominal operations and morbid obesity (body mass index 48 kg/m2). Three patients with pathology-confirmed AM were incorrectly diagnosed preoperatively as symptomatic retroperitoneal mass (30 cm) concerning for malignancy, enlarging non-functioning cortical tumor (8 cm), and non-functioning adenoma (2.8 cm) in a kidney transplant candidate. In this group, 1 underwent LA and 2 OA due to mass size (30 cm) and concern for malignancy. Patients who underwent LA for AM (n=13) were statistically similar to those who underwent LA for other adrenal pathology (n=343) with respect to age (51.0±8.7 vs. 49.4±14.6 years), gender (female 62% vs. 54%), American Society of Anesthesiology classification (2.2 ± .4 vs. 2.5 ± .6), prior abdominal operation (46% vs. 46%), tumor side (left 54% vs. 52%), operative time (160 ± 64.6 vs. 159 ± 69 min), conversion to open (0% vs. 6.1%), estimated blood loss (≤100 ml in 92% vs. 81%), intraoperative complications (0% vs. 3.5%), hospital length of stay (1.7 ± .9 vs. 2.6 ± 2.2 days), and 30-day morbidity (0% vs. 11%). However, patients with AM had a higher body mass index (35.2 ± 6.1 vs. 30.1 ± 7.5 kg/m2, p<.01), and a larger preoperative tumor size (8.4 ± 3.0 vs. 3.1±1.7 cm, p<.01).
Conclusions: LA is appropriate for patients with a preoperative diagnosis of adrenal myelolipoma and related abdominal or flank pain, large tumor size, and/or uncertain diagnosis after imaging. In selected patients, the safety and perioperative outcomes of LA appear similar for AM and other adrenal pathology.
Session Number: Poster – Poster Presentations
Program Number: P595