Surgical approaches of adrenal tumors( report of 1077 cases)

Objective To identify the optimal surgical approaches for the resection of adrenal tumors. Methods The choices and effects of surgical approaches in 1 077 patients with adrenal tumors of varying sizes and types were analyzed. Results An 11th or 10th intercostal incision was used for 567 cases of aldosterone-producing adrenocortical tumors (APA) and Cushing syndrome (CUS). An llth or 10th incision was used in 173 cases of pheochromocytomas and 136 cases of incidental tumors. Transabdominal approach was performed in 136 cases of pheochromocytomas and 22 cases of incidental tumors. Twenty-five patients recieving thoracoabdominal approach were all those with pheochromocytomas or incidental tumors. Nine patients with adrenal tomors less than 4 cm in diameter received laparoscopic surgery. Surgeries included 1 060 cases of tumor resection and 17 cases of biopsies, and splenectomy was procedured in 9 patients simultaneously. The main complication of 11th or 10th intercostal incision approach was pleural

Objective To identify the optimal surgical approaches for the resection of adrenal tumors. Methods The choices and effects of surgical approaches in 1 077 patients with adrenal tumors of varying sizes and types were analyzed. Results An 11th or 10th intercostal incision was used for 567 cases of aldosterone-producing adrenocortical tumors (APA) and Cushing syndrome (CUS). An llth or 10th incision was used in 173 cases of pheochromocytomas and 136 cases of incidental tumors. Transabdominal approach was performed in 136 cases of pheochromocytomas and 22 cases of incidental tumors. Twenty-five patients recieving thoracoabdominal approach were all those with pheochromocytomas or incidental tumors. Nine patients with adrenal tomors less than 4 cm in diameter received laparoscopic surgery. Surgeries included 1 060 cases of tumor resection and 17 cases of biopsies, and splenectomy was procedured in 9 patients simultaneously. The main complication of 11th or 10th intercostal incision approach was pleural injury, and transabdominal approach had its main complication of spleen injury. Conclusion An 11th or 10th intercostal incision is the best choice for patients with APA, CUS and pheochromocytoma or incidental tumor less than 7 cm in diameter. For tumors greater than 7 cm, transabdominal or thoracoabdominal approach is indicated. Transabdominal approach is also indicated for extra-adrenal or multiple pheochromocytomas and bilateral adrenal tumors. The 11th or 10th intercostal incisions or thoracoabdominal incisions provide more chances of renal vessel repair and renal sparing compared with transabdominal approach for pheochromocytomas adjacent to the renal vascular pedicle. Laparoscopic surgery is suitable for patients with adrenal tumors less than 6 cm in diameter. 5 refs,2 tabs.