Laparoscopic Adrenalectomy for Malignant Lesions – Safe and Effective!

Gideon Sroka, MD MSc, Nadav Slijper, MD, Dan Shteinberg, MD, Husam Mady, MD, Ibrahim Mattar, MD. Bnai-Zion Medical Center, Technion – Israel Institute of Technology, Haifa, Israel

Introduction: Laparoscopic Adrenalectomy (LA) is the treatment of choice for benign adrenal lesions. Size of the lesion and radiologic features define the risk for malignancy. In lesions with high risk of malignancy the experience with the laparoscopic approach is limited and therefore controversial. The purpose of this study is to determine the feasibility and oncological safety of LA for malignant disease.Methods: Retrospective analysis of prospectively collected database. All LA performed in our department between 2003-2011 were reviewed and demographic, perioperative and follow up data for those who had malignancy in the final histological report was analyzed. Data is presented as mean(range). Results: Out of 121 LA we identified 20 patients with 21 malignant adrenal pathologies: 11 primary tumors: 5 Adreno Cortical Carcinoma; 5 Large B cell Lymphoma; 1 Leomyosarcoma. 10 Metastatic lesions included 5 Malignanat Melanoma (1 Patient- both sides); 4 Adeno-Carcinoma and 1 Renal Cell Carcinoma. There was no conversion to laparotomy. Mean tumor size was 7 (5-9)cm, operative duration was 70(45-145)min, estimated blood loss was 80(20-500)cc. All patients resumed regular diet on POD 1 and mean length of stay was 2.4 days. 2 patients died 6 & 24 months post operatively. 2 patients were lost to follow up. All the rest of the patients are alive and well with mean follow up of 46(7-96) months. Conclusions: LA for primary or metastatic malignant lesions is feasible and oncologically safe. Surgical principles should be the same for all LA: Enbloc resection of all epinephric fat, minimal touch technique and low threshold for conversion. Size alone should not be an indication for open surgery.