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Annales D'endocrinologie Jul 2016Treatment of primary aldosteronism (PA) aims at preventing or correcting hypertension, hypokalemia and target organ damage. Patients with lateralized PA and candidates...
Treatment of primary aldosteronism (PA) aims at preventing or correcting hypertension, hypokalemia and target organ damage. Patients with lateralized PA and candidates for surgery may be managed by laparoscopic adrenalectomy. Partial adrenalectomy and non-surgical ablation have no proven advantage over total adrenalectomy. Intraoperative morbidity and mortality are low in reference centers, and day-surgery is warranted in selected cases. Spironolactone administered during the weeks preceding surgery controls hypertension and hypokalemia and may prevent postoperative hypoaldosteronism. In most cases, surgery corrects hypokalemia, improves control of hypertension and reduces the burden of pharmacologic treatment; in about 40% of cases, it resolves hypertension. However, success in controlling hypertension and reversing target organ damage is comparable with mineralocorticoid receptor antagonists. Informed patient preference with regard to surgery is thus an important factor in therapeutic decision-making.
Topics: Adrenalectomy; France; Humans; Hyperaldosteronism; Hypertension; Hypokalemia; Intraoperative Complications; Laparoscopy; Mineralocorticoid Receptor Antagonists; Postoperative Complications; Spironolactone; Treatment Outcome
PubMed: 27297451
DOI: 10.1016/j.ando.2016.01.009 -
Hipertension Y Riesgo Vascular 2023Primary aldosteronism (PA) is the most common cause of secondary arterial hypertension. For unilateral cases, surgery offers the possibility of cure, with unilateral... (Review)
Review
Primary aldosteronism (PA) is the most common cause of secondary arterial hypertension. For unilateral cases, surgery offers the possibility of cure, with unilateral adrenalectomy being the treatment of choice, whereas bilateral forms of PA are treated mainly with mineralocorticoid receptor antagonists (MRA). The goals of treatment for PA due to either unilateral or bilateral adrenal disease include reversal of the adverse cardiovascular effects of hyperaldosteronism, normalization of serum potassium in patients with hypokalemia, and normalization of blood pressure. The Primary Aldosteronism Surgery Outcome group (PASO) published a study defining clinical and biochemical outcomes based on blood pressure and correction of hypokalemia and aldosterone to renin ratio (ARR) levels for patients undergoing total unilateral adrenalectomy for unilateral PA. In this review, we provide several practical recommendations for the medical and surgical management and follow-up of patients with PA.
Topics: Humans; Aldosterone; Hypokalemia; Follow-Up Studies; Hyperaldosteronism; Hypertension; Adrenalectomy
PubMed: 37993292
DOI: 10.1016/j.hipert.2023.08.001 -
Journal of Endourology May 2018Adrenalectomies are increasingly performed using minimally invasive approaches. The widespread adoption of robot-assisted laparoscopy for other urologic surgeries has...
Adrenalectomies are increasingly performed using minimally invasive approaches. The widespread adoption of robot-assisted laparoscopy for other urologic surgeries has dramatically increased the popularity of this approach for adrenal surgery.
Topics: Adrenal Gland Neoplasms; Adrenalectomy; Humans; Intraoperative Complications; Laparoscopy; Neoplasm Metastasis; Obesity; Patient Positioning; Pheochromocytoma; Postoperative Period; Preoperative Period; Robotic Surgical Procedures; Robotics; Urologic Surgical Procedures
PubMed: 29774815
DOI: 10.1089/end.2017.0721 -
American Journal of Surgery Aug 2020
Topics: Adrenal Gland Neoplasms; Adrenalectomy; Ambulatory Care; Female; Humans; Male; Middle Aged; Patient Safety; Patient Selection; Retrospective Studies; Robotic Surgical Procedures
PubMed: 32402438
DOI: 10.1016/j.amjsurg.2020.04.037 -
Current Opinion in Oncology Jan 2020The aim of this article is to focus on state-of-the-art minimally invasive adrenalectomy (MIA) and the most recent role of open adrenalectomy for adrenal tumours,... (Review)
Review
PURPOSE OF REVIEW
The aim of this article is to focus on state-of-the-art minimally invasive adrenalectomy (MIA) and the most recent role of open adrenalectomy for adrenal tumours, respect to MIA and open adrenalectomy for adrenocortical cancer (ACC).
RECENT FINDINGS
The laparoscopic (both transperitoneal and retroperitoneal) approach is the first-choice treatment in cases of small-to-medium benign adrenal tumours. This approach is feasible and well tolerated even for larger lesions without radiological signs of malignancy. Robotic adrenalectomy has recently increased in popularity, although the results appear to be fully comparable with those of laparoscopy. Open approach is the keystone of ACC surgery, especially when neighbour tissues, organs, or vessels are involved. Recent evidence suggests caution in treating localized ACC with laparoscopy, because of the higher rate of local or peritoneal recurrence, and shorter recurrence-free survival rates with respect to open adrenalectomy.
SUMMARY
MIA has progressively replaced the traditional open approach and plays a complementary role in the treatment of adrenal tumour. It is the first option for benign lesions, whereas open adrenalectomy is a cornerstone treatment for ACC. The overlap of indications for laparoscopic adrenalectomy and open adrenalectomy is today confined to the treatment of organ-confined adrenal cancer, in which the role of laparoscopic surgery is far from being clearly defined.
Topics: Adrenal Gland Neoplasms; Adrenalectomy; Humans; Minimally Invasive Surgical Procedures; Randomized Controlled Trials as Topic; Robotic Surgical Procedures
PubMed: 31644473
DOI: 10.1097/CCO.0000000000000594 -
Langenbeck's Archives of Surgery Dec 2019In Europe, the Division of Endocrine Surgery (DES) determines the number of operations (thyroid, neck dissection, parathyroids, adrenals, neuroendocrine tumors of the... (Review)
Review
BACKGROUND/PURPOSE
In Europe, the Division of Endocrine Surgery (DES) determines the number of operations (thyroid, neck dissection, parathyroids, adrenals, neuroendocrine tumors of the gastro-entero-pancreatic tract (GEP-NETs)) to be required for the European Board of Surgery Qualification in (neck) endocrine surgery. However, it is the national surgical boards that determine how surgical training is delivered in their respective countries. There is a lack of knowledge on the current situation concerning the training of surgical residents and fellows with regard to (neck) endocrine surgery in Europe.
METHODS
A survey was sent out to all 28 current national delegates of the DES. One questionnaire was addressing the training of surgical residents while the other was addressing the training of fellows in endocrine surgery. Particular focus was put on the numbers of operations considered appropriate.
RESULTS
For most of the operations, the overall number as defined by national surgical boards matched quite well the views of the national delegates even though differences exist between countries. In addition, the current numbers required for the EBSQ exam are well within this range for thyroid and parathyroid procedures but below for neck dissections as well as operations on the adrenals and GEP-NETs.
CONCLUSIONS
Training in endocrine surgery should be performed in units that perform a minimum of 100 thyroid, 50 parathyroid, 15 adrenal, and/or 10 GEP-NET operations yearly. Fellows should be expected to have been the performing surgeon of a minimum of 50 thyroid operations, 10 (central or lateral) lymph node dissections, 15 parathyroid, 5 adrenal, and 5 GEP-NET operations.
Topics: Adrenalectomy; Career Choice; Clinical Competence; Education, Medical, Graduate; Endocrine Surgical Procedures; Europe; Female; Humans; Internship and Residency; Male; Parathyroidectomy; Surveys and Questionnaires; Thyroidectomy
PubMed: 31701231
DOI: 10.1007/s00423-019-01828-4 -
Surgical Endoscopy Aug 2016Technological advances have brought about robotic single-site (RSS) cholecystectomy and hysterectomy. The application of RSS to additional procedures requires careful...
INTRODUCTION
Technological advances have brought about robotic single-site (RSS) cholecystectomy and hysterectomy. The application of RSS to additional procedures requires careful assessment of the surgeon learning curve, the technological limitations, patient selection criteria and associated outcomes.
METHODS
Patient demographics, BMI, surgical indications, adrenal size, OR times, length of stay, postoperative pain and complications were assessed.
RESULTS
Thirty-three patients underwent RSS-A by a single surgeon with 53 % being male, mean age 54 ± 16 years and mean BMI of 32.7. There were 18 left, 10 right, and 5 bilateral procedures for a total of 38 adrenal glands removed (mean tumor size 3.2 cm). There were 5 conversions to a laparoscopic approach, and two to open approach. The necessity for conversion was not associated with age, BMI, tumor size, surgical side or pathology (p > 0.05). The patients who underwent successful unilateral RSS-A had a profile of mean age 55, BMI 31, tumor size 3 cm, and a mean operative time of 118 ± 25.8 min. Pain scores were <4 (10 point scale) in 67 % of patients. 74 % of patients were discharged on POD 1 and 96 % were discharged by POD 2. An assessment of the quartile learning curve for the unilateral RSS-A showed operative times decreased from a mean of 124 to 103 min after 21 cases (p = 0.05).
CONCLUSION
Patients with functioning and non-functioning tumors, along with those with obesity can safely be treated with RSS-A. The surgeon learning curve was associated with shortened operative times and not increased complication rates.
Topics: Adrenalectomy; Female; Humans; Laparoscopy; Learning Curve; Male; Middle Aged; Operative Time; Pain Measurement; Pain, Postoperative; Retrospective Studies; Robotic Surgical Procedures
PubMed: 26487220
DOI: 10.1007/s00464-015-4611-1 -
The Surgical Clinics of North America Aug 2019Given the frequent use of cross-sectional imaging in medicine, adrenal masses are discovered at an increasing rate. Once detected, it is critical to ensure the patient... (Review)
Review
Given the frequent use of cross-sectional imaging in medicine, adrenal masses are discovered at an increasing rate. Once detected, it is critical to ensure the patient undergoes the appropriate biochemical/hormonal workup to rule out any aberrant activity and ensure imaging features do not raise suspicion for a malignant neoplasm. Patients with hormonal overactivity, concerning size, and/or imaging characteristics must be referred for surgical consideration. For those not requiring adrenalectomy, it is important to determine which patients mandate follow-up to ensure no further growth or development of hormonal production. It is also critical to understand what is the appropriate follow-up.
Topics: Adrenal Gland Neoplasms; Adrenalectomy; Diagnosis, Differential; Humans; Incidental Findings
PubMed: 31255202
DOI: 10.1016/j.suc.2019.04.009 -
Updates in Surgery Jun 2017Open adrenalectomy still plays an important role in adrenal surgery. A review of the current literature has been carried out to discuss the main indication to open... (Review)
Review
Open adrenalectomy still plays an important role in adrenal surgery. A review of the current literature has been carried out to discuss the main indication to open adrenalectomy with regards to the main adrenal pathologies. The authors underlined the role of open adrenalectomy on the basis of personal experience and a literature review. Indication to open adrenalectomy for adrenal cysts, myelolipomas, pheochromocytomas, metastases, adrenocortical carcinomas and tumour recurrences were analysed and discussed. Open adrenalectomy has still an important role in several adrenal pathologies: it is mandatory in some specific situations, such as big lesions, risk of malignancy, emergency settings and in case of recurrent tumoral disease.
Topics: Adrenal Gland Diseases; Adrenal Gland Neoplasms; Adrenalectomy; Humans; Laparoscopy; Neoplasm Recurrence, Local
PubMed: 28540670
DOI: 10.1007/s13304-017-0440-1 -
Best Practice & Research. Clinical... May 2020Adrenocortical carcinoma (ACC) is a rare malignancy that is frequently asymptomatic at presentation, yet has a high rate of metastatic disease at the time of diagnosis.... (Review)
Review
Adrenocortical carcinoma (ACC) is a rare malignancy that is frequently asymptomatic at presentation, yet has a high rate of metastatic disease at the time of diagnosis. Prognosis is overall poor, particularly with cortisol-producing tumors. While the treatment of ACC is guided by stage of disease, complete surgical resection is the most important step in the management of patients with primary, recurrent, or metastatic ACC. Triphasic chest, abdomen, and pelvis computer tomography (CT) scans and 18F flourodeoxyglucose positron emission tomography CT scanning are essential for accurate staging; moreover, MRI may be helpful to identify liver metastasis and evaluate the involvement of adjacent organs for operative planning. Surgical resection with negative margins is the single most important prognostic factor for survival in patients with ACC. To achieve the highest rate of R0 resection, open adrenalectomy is the gold standard surgical approach for confirmed or highly suspected ACC. It is extremely important that the tumor capsule is not ruptured, regardless of the surgical approach used. The best post-operative outcomes (complications and oncologic) are achieved by high-volume surgeons practicing at high-volume centers.
Topics: Adrenal Cortex Neoplasms; Adrenalectomy; Adrenocortical Carcinoma; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Neoplasm Metastasis; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Prognosis; Time Factors; Tomography, X-Ray Computed
PubMed: 32265101
DOI: 10.1016/j.beem.2020.101408