The approach to the incidental tumors of adrenal glands hasn't been well established yet. A serial follow-up has been suggested for small tumors, the surgical treatment being reserved to medium to big size incidentalomas (more than 3-6 cm). The authors analyze their case series of incidentalomas to evaluate adrenalectomy as first choice approach to the incidental tumors of adrenal glands. The case material consisted of 19 patients aged between 39 and 77 years [54.3 ± 7.3 years (mean ± SE)], with silent adrenal tumor incidentally discovered by ultrasound (14 cases) or CT-scan (5 cases). Thirteen patients underwent laparotomy through anterior transperitoneal approach while 4 patients were surgically treated through a laparoscopic approach with anterior and lateral transperitoneal ports: 8 patients underwent tumor excision, 4 patients underwent right adrenalectomy, 4 patients underwent left adrenalectomy and 1 patient underwent bilateral adrenalectomy. Two cases were not operated due to patient refusal. The length of operation was 3.1 ± 1.7 hours (mean ± SE) when performed through laparotomy, and 2.0 ± 1.4 hours when performed through laparoscopy. No cases required intra-postoperative blood transfusions. The length of postoperative ileus was 3.3 ± 1.8 days and 2.5 ± 1.5 days in the laparotomic and laparoscopic group, respectively. The length of postoperative hospitalization was 3.2 ± 1.8 days for the patients who had laparoscopic adrenalectomy and 9.2 ± 3.0 days for the patients who underwent laparotomy. No intra-postoperative complications were recorded in the laparoscopic group, while 2 wound infections were recorded (in 1 case with partial dehiscence of the abdominal wall closure) among the patients operated through laparotomy. Significance tests were not performed due to the small laparoscopic population. Out of 17 surgically treated patients, 14 incidentalomas turned to be adrenal cortex adenomas (82%), 1 case pheochromocytoma (6%), 1 case myelolipoma (6%) and 1 case bilateral adrenal metastasis from hepatocellular carcinoma (6%). Tumor size ranged between 2.5 cm and 7.5 cm (4.25 ± 2 cm, mean ± SE). In the laparoscopic group tumor sizes were 2.5 cm (3 cases) and 2.8 cm (1 case). In spite of a benign diagnosis in all our patients and in consideration of lack of studies demonstrating the diagnostic effectiveness of an association MRI-scintigraphy-FNAB, we believe that the interventional approach to adrenal incidentaloma represents the only reliable chance for an early diagnosis of adrenal carcinoma, otherwise characterized by a poor short term prognosis. Laparoscopic tecniques for adrenalectomy can allow a surgical approach to any incidental tumor of the adrenal gland, without any cut off based on tumor size.
|Translated title of the contribution||Incidental tumor of the adrenal gland. The chance for an early diagnosis of adrenal carcinoma|
|Number of pages||5|
|Publication status||Published - 1996|
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