July - September 2014, Volume 10, Issue 3

Harza MC, Preda AT, Ismail G, Voinea S, Dudu CE, Baston C, Olaru V, Daia D, Mitroi I, Hortopan M, Sinescu I

Extent and Type of Surgery in Adrenal Masses

Acta Endo (Buc) 2014, 10 (3): 404-413
doi: 10.4183/aeb.2014.404

Background. Indication, type of surgery and choice of surgical approach for adrenal masses continues to be a subject of debate between surgeons. The aim of this study was to report our data and experience with adrenal surgery. Subjects and Methods. We performed a retrospective study on 297 patients diagnosed with adrenal masses and operated in our center between 2002 and 2011. Gender, age, surgical approach, operating time, hospital stay, histology report and complications were analyzed. Results. From a total of 297 patients who underwent adrenalectomies, 82 were performed by laparoscopic approach and 215 in a classical open approach. The most common indication for surgery was pheochromocytoma (50.2% in unilateral and 50% in bilateral adrenal masses) summing 149 patients for both types of surgery. The risk of malignancy was significantly correlated with tumor size and the cut off value of 5cm had 92.5% specificity and 74.6% sensitivity. Patients in laparoscopic group were younger (mean 44.13 years), had shorter operating times (mean 122.7 min), shorter hospital stays (mean 6.8 days), and less complications (1.7 %) compared to open adrenalectomy. Conversion rate to open procedure was 2.4 %. Conclusion. Although many adrenal masses are now excised by laparoscopic techniques, the number of procedures was still low in our center because of high surgical complexity of our cases and high institutional costs. Moreover, we should consider that the best adrenal surgery approach remains open surgical excision for larger masses and malignant conditions.

Keywords: adrenal mass, incidentaloma, surgery, adrenalectomy, adrenocortical carcinoma.

Correspondence: Adrian Preda MD, Fundeni Clinical Institute, Center for Uronephrology and Renal Transplantation, 258 Fundeni Street, Bucharest, Romania, 022328, Email: a.t.preda@gmail.com