PRACTICAL ASPECTS OF LAPAROSCOPIC ADRENALECTOMY IN CHILDREN WITH BENIGN ADRENAL TUMORS

Introduction. Despite of almost 30-year world experience in mini-invasive adrenalectomy in non-oncologic pediatric patients, this issue remains not fully understood and systematized in the domestic literature. Material and methods. Our work is based on 67 laparoscopic adrenalectomies performed in 65 patients, aged from 3 months to 17 years, with predominantly benign neoplasms. Despite of a thorough preoperative examination of each patient, we met malignant neoplasms in 7 cases: 4 - adrenocortical cancer and 3 - neuroblastomas (further they were treated by oncologists). Location of the neoplasms was as follows: right-sided - 31, left-sided - 26, bilateral - 8 (6 patients out of them had bilateral simultaneous removal). Average size of the removed formations was 4.65 ± 1.29 cm (maximum 12 cm). Results and discussion. The vast majority of detected adrenal neoplasms are removed. Exceptions may be neoplasms less than 4 cm in diameter with the native density less than 10 HU by computed tomography; however, they should be actively monitored by specialists. If a malignant process is suspected, patients should be examined more thoroughly and should be treated in specialized hospitals. Nowadays, a minimally invasive and safe surgical treatment of neoplasms in the adrenal glands depends on the experience and trainings of surgeons and anesthesiologists, as well as on the equipment in the operating room. A key to the successful treatment of patients with benign adrenal neoplasms is a specific attention to curative peculiarities in such patients as well as an adequate sequence of actions during laparoscopic adrenalectomy in its main stage, namely, ligation of the central adrenal vein.

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Modern possibilities of the urine steroid profile testing applying for the adrenocortical cancer diagnosis

Endocrine Surgery ◽

10.14341/serg12307 ◽

2020 ◽

Vol 14 (1) ◽

pp. 4-13

Author(s):

Ilya E. Shcherbakov ◽

Roman A. Chernikov ◽

Vladimir F. Rusakov ◽

Elysey A. Fedorov ◽

Uriy N. Fedotov ◽

...

Keyword(s):

Cancer Diagnosis ◽

Diagnostic Method ◽

Diagnostic Methods ◽

Gas Chromatography Mass Spectrometry ◽

Adrenal Tumors ◽

Adrenocortical Cancer ◽

X Ray ◽

Adrenal Neoplasms ◽

Steroid Profile ◽

Urine Steroid

BACKGROUND: X-ray diagnostics methods are important in detection of adrenal neoplasms malignant nature. The sensitivity and specificity of these methods are high enough. However the hormonal tests are also necessary to make an accurate clinical diagnosis with the high diagnostic efficiency of modern X-ray methods for adrenal tumors diagnosing. The urine steroid profile violations are detected with the adrenal glands various pathologies (primary hyperaldosteronism, hypercorticism, congenital hyperplasia of the adrenal cortex and adrenocortical cancer). Urine steroid profile tests in patients with diagnosed adrenal neoplasms are intended primarily to confirm or refute the adrenocortical cancer risk. At the same time in the medical community to date there are a number of disagreements accumulated regarding the accuracy and significance of the urine steroid profile tests. AIMS: The study aims to determine the urine steroid profile determination accuracy limits for the adrenocortical cancer diagnosis. MATERIALS AND METHODS: In total 62 samples were tested for urine steroid profile by gas chromatography-mass spectrometry. 58 patients had morphologically confirmed adrenal neoplasms. The study was blind prospective. To increase the study accuracy the 30 patients with adrenocortical adenomas (n = 17) and adrenocortical cancer (n = 13) were selected out of 58 tested persons. The sensitivity, specificity and accuracy of the urine steroid profile were determined in order to assess information content of such method for the adrenocortical carcinoma diagnosis. RESULTS: The possibilities of the urine steroid profile determining for the adrenocortical cancer diagnosis are estimated. The method sensitivity was 46.2%, specificity and accuracy were 70.6% and 60% respectively. The most reliable of adrenocortical cancer markers were tetrahydro-11-deoxycortisol and dehydroepiandrosterone (38.5% of cases) increasing concentrations. CONCLUSIONS: The present study demonstrates relatively low diagnostic efficacy of the urine steroid profile as a primary diagnostic method for adrenocortical cancer determining. This is especially evident in comparison with X-ray diagnostic methods. The technique interpretation is complex and accessible only to specialists with extremely high qualifications. Such fact complicates the distribution and widespread use in clinical practice of this testing method. At the same time the urine steroid profile determination in the future (after additional study) may be apply as an auxiliary diagnostic method which in some cases determines the treatment tactics for patients undergoing adrenocortical cancer adrenalectomy treatment.KEYWORDS: dPheochromocytoma; intraoperative hemodynamic instability; laparoscopic adrenalectomy; Endovascular embolization of preoperative; сase report.

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A Comparative Study of the Transperitoneal and Posterior Retroperitoneal Approaches for Laparoscopic Adrenalectomy for Adrenal Tumors

Annals of Surgical Oncology ◽

10.1245/s10434-012-2352-0 ◽

2012 ◽

Vol 19 (8) ◽

pp. 2629-2634 ◽

Cited By ~ 54

Author(s):

Cho Rok Lee ◽

Martin K. Walz ◽

Seulkee Park ◽

Jae Hyun Park ◽

Jun Soo Jeong ◽

...

Keyword(s):

Comparative Study ◽

Laparoscopic Adrenalectomy ◽

Adrenal Tumors

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Fascin-1 Is a Novel Prognostic Biomarker Associated With Tumor Invasiveness in Adrenocortical Carcinoma

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2018-01717 ◽

2018 ◽

Vol 104 (5) ◽

pp. 1712-1724 ◽

Cited By ~ 6

Author(s):

Giada Poli ◽

Carmen Ruggiero ◽

Giulia Cantini ◽

Letizia Canu ◽

Gianna Baroni ◽

...

Keyword(s):

Disease Free Survival ◽

Tumor Stage ◽

Labeling Index ◽

University Hospital ◽

Adrenal Tumors ◽

Adrenocortical Cancer ◽

Tumor Spread ◽

Adrenocortical Tumors ◽

Tumor Invasiveness ◽

Ki67 Labeling Index

Abstract Context Novel tumor markers are urgently needed to better stratify adrenocortical cancer (ACC) patients and improve therapies for this aggressive neoplasm. Objective To assess the diagnostic and prognostic value of the actin-bundling protein fascin-1 (FSCN1) in adrenocortical tumors. Design, Setting and Participants A local series of 37 malignant/37 benign adrenocortical tumors at Careggi University Hospital and two independent validation ACC cohorts (Cochin, TCGA) from the European Network for the Study of Adrenal Tumors were studied. Main Outcome Measures FSCN1 expression was quantified by immunohistochemistry, Western blot and quantitative RT-PCR in ACC specimens; overall and disease-free survival associated with FSCN1 expression were assessed by Kaplan-Meier analysis and compared with that of Ki67 labeling index and tumor stage. Results Despite the low diagnostic power, in the Florence ACC series, FSCN1 immunohistochemical detection appeared as an independent prognostic factor, also refining results obtained with staging and Ki67 labeling index. The robust prognostic power of FSCN1 levels was further confirmed in two independent ACC cohorts. A positive correlation was found between FSCN1 and steroidogenic factor-1 (SF-1), with a substantially higher expression of both factors in ACCs at advanced stages and with at least one of the three Weiss score parameters associated with invasiveness. Moreover, we demonstrated FSCN1 role in promoting cell invasion in a human ACC cell line only in the case of increased SF-1 dosage. Conclusions These findings show that FSCN1 is a novel independent prognostic marker in ACC and may serve as a potential therapeutic target to block tumor spread.

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Laparoscopic Adrenalectomy for Pheochromocytoma: Comparison with Open Adrenalectomy and Comparison of Laparoscopic Surgery for Pheochromocytoma versus Other Adrenal Tumors

Journal of Endourology ◽

10.1089/end.2000.14.427 ◽

2000 ◽

Vol 14 (5) ◽

pp. 427-431 ◽

Cited By ~ 37

Author(s):

MASATOSHI TANAKA ◽

NORIAKI TOKUDA ◽

HIROHUMI KOGA ◽

YASUSUKE KIMOTO ◽

SEIJI NAITO

Keyword(s):

Laparoscopic Surgery ◽

Laparoscopic Adrenalectomy ◽

Adrenal Tumors ◽

Open Adrenalectomy

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Retrospective comparison of three minimally invasive approaches for adrenal tumors: perioperative outcomes of transperitoneal laparoscopic, retroperitoneal laparoscopic and robot-assisted laparoscopic adrenalectomy

BMC Urology ◽

10.1186/s12894-020-00637-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Changwei Ji ◽

Qun Lu ◽

Wei Chen ◽

Feifei Zhang ◽

Hao Ji ◽

...

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

Minimally Invasive ◽

Laparoscopic Adrenalectomy ◽

Perioperative Outcomes ◽

Adrenal Tumors ◽

Transfusion Rate ◽

Robot Assisted ◽

Estimated Blood Loss ◽

Minimally Invasive Adrenalectomy

Abstract Background To compare the perioperative outcomes of transperitoneal laparoscopic (TLA), retroperitoneal laparoscopic (RLA), and robot-assisted transperitoneal laparoscopic (RATLA) adrenalectomy for adrenal tumors in our center. Methods Between April 2012 and February 2018, 241 minimally invasive adrenalectomies were performed. Cases were categorized based on the minimally invasive adrenalectomy technique. Demographic characteristics, perioperative information and pathological data were retrospectively collected and analyzed. Results This study included 37 TLA, 117 RLA, and 87 RATLA procedures. Any two groups had comparable age, ASA score, Charlson Comorbidity Index, and preoperative hemoglobin. The tumor size for RLA patients was 2.7 ± 1.1 cm, which was significantly smaller compared to patients who underwent TLA/RATLA (p = 0.000/0.000). Operative time was similar in any two groups, while estimated blood loss was lower for RATLA group (75.6 ± 95.6 ml) compared with the TLA group (131.1 ± 204.5 ml) (p = 0.041). Conversion to an open procedure occurred in only one (2.7%) patient in the TLA group for significant adhesion and hemorrhage. There were no significant differences between groups in terms of transfusion rate and complication rate. Length of stay was shorter for the RATLA group versus the TLA/RLA group (p = 0.000/0.029). In all groups, adrenocortical adenoma and pheochromocytoma were the most frequent histotypes. Conclusions Minimally invasive adrenalectomy is associated with expected excellent outcomes. In our study, the RATLA approach appears to provide the benefits of decreased estimated blood loss and length of stay. Robotic adrenalectomy appears to be a safe and effective alternative to conventional laparoscopic adrenalectomy.

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DIAGNOSTICS AND TREATMENT OF PATIENTS WITH SUBCLINICAL FORMS OF HORMONAL-ACTIVE ADRENAL TUMORS

Tavricheskiy Mediko-Biologicheskiy Vestnik ◽

10.37279/2070-8092-2020-23-2-181-186 ◽

2020 ◽

Vol 23 (2) ◽

pp. 181-186

Author(s):

P. N. Romashchenko ◽

N. A. Maistrenko ◽

S. G. Bliumina ◽

A. M. Ivanov

Keyword(s):

Liquid Chromatography ◽

Blood Plasma ◽

Dehydroepiandrosterone Sulfate ◽

Diagnostic Methods ◽

Adrenal Tumors ◽

Laboratory Diagnostics ◽

Adrenocortical Cancer ◽

Catecholamine Metabolites ◽

In Blood Plasma

The increased incidence of accidental revealing adrenal tumors in radiation studies requires further improvement of laboratory diagnostic methods for the timely detection of their latent hormonal activity and malignancy potential, as well as the determination of strategic therapeutic approaches. The aim of the work was to evaluate the capabilities of modern laboratory diagnostics in verification of latent forms of hormone-active adrenal tumors to determine further treatment tactics. The study included 207 (14.9%) of 1390 patients in whom the hormones precursors of steroidogenesis and catecholamine metabolites were studied in blood plasma by liquid chromatography, as well as tumor markers. These patients were divided into a group of subclinical forms of hormone-active NP tumors (n = 173) and a group of truly hormone-inactive formations (n=34). It has been established that pre-aldosteroma is characterized with an increase of corticosterone (8.1±3.4 ng/ml), 11-deoxycorticosterone (12.3±3.0 ng/ml), 18-hydroxycorticosterone (5.4±1,4 ng/ml) in blood. For pre-corticosteroma: increased cortisol (119.2±16.1 ng/ml), 11-deoxycortisol (11.5±1.9 ng/ml), 11-deoxycorticosterone (12.8±2.1 ng/ml), the ratio of cortisol/cortisone (9.1±1.6 ng/ml) in blood. The presence of «silent» pheochromocytoma was confirmed by an increase of blood free methanephrine (105.0±27.1 ng/ml) and normetanephrine (196.0±43.6 ng/ml), as well as chromogranin A (223.3±15.3 pg/ml). The latent forms of adrenocortical cancer were characterized by an increase in blood dehydroepiandrosterone sulfate (45.2±3.9 μmol/L), cancer embryo antigen (9.8±1.2 ng/ml), vascular endothelial growth factor (1122.0±24.5 ng/ml), IL-6 (95.4±1.8 pg/ml), 11-deoxycortisol (21.8±4.5 ng/ml), 11-deoxycorticosterone (4.2±3.2 ng/ml). All 173 patients with hormone-active NP tumors, as well as 30 (88.2%) with large (6.5±2.0 cm) hormone-inactive formations with the presence of compression syndrome, underwent adrenalectomy. Determination of the precursors of steroidogenesis and catecholamine metabolites in blood plasma by liquid chromatography can reliably identify the functional activity of adrenal tumors and determine their malignant potential, as well as substantiate indications for timely surgical treatment.

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