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Adrenal metastases
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Khawaja Shahabuddin, Rodney H Reznek, Anju Sahdev
Several small studies have reported a survival benefit following adrenelectomy for isolated adrenal metastases in non-small cell lung cancer (NSCLC) and malignant melanoma (28,29). In NSCLC, resection of the primary carcinoma (stage 1) and an adrenal metastases can be curative. The best results are obtained for adrenal metastases less than 4.5 cm with a median survival of 30 months and an estimated 5-year survival of 31%–33% (28). In malignant melanoma, however, the median survival was only 6.4 months but even this was still a statistically significant survival benefit when compared to the non-operative group (30,31). The adrenalectomy may be performed as an open, laparoscopic, or robotic procedure. The initial results show laparoscopic and robotic surgery perform as well as open surgery in terms of resection margins, complications, cost effectiveness, hospital stay, survival, and disease-free rates (32,33).
Oncology
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Surgical treatment options for excision of breast cancer include mastectomy (radical, extensive radical, modified radical, simple [total], or subcutaneous), and lumpectomy (tylectomy). Oophorectomy (removal of the ovaries) is another surgical procedure sometimes used to reduce the level of endogenous ovarian hormones and temporarily regress hormone-dependent tumors. Adrenalectomy and hypophysectomy (excision of the adrenal and pituitary glands, respectively) are also utilized to decrease hormone secretions. Radiation therapy has been used for all types of breast cancer as primary, adjuvant, and palliative treatment. A number of chemotherapeutic agents are used successfully in treatment, particularly in multidrug regimens. Hormonal manipulation has also been a significant addition to treatment options. Use is determined by the presence of estrogen receptor protein (ERP) in the tumor tissue.
Cushing’s syndrome, cortical carcinoma, and estrogen- and androgen-secreting tumors
Published in Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner, Endocrine Surgery, 2017
Mitotane is the only adrenolytic agent commonly used, and its mechanism of action in reducing plasma cortisol appears to be multifactorial [106]. Primarily used in the treatment of adrenal cortical carcinoma, it can be used as a medical adrenalectomy in patients with Cushing’s syndrome. The rationale for use is supported by a low level of evidence, derived from small retrospective studies in which the reported response rate ranges from 59% to 70% [103, 107].
Laparoscopic Treatment of Large Adrenal Tumor is Safe and Effective? A Single Center Experiences
Published in Journal of Investigative Surgery, 2021
Juping Zhao, Wenming Ma, Jialing Xie, Jun Dai, Xin Huang, Chen Fang, Wei He, Fukang Sun
The first laparoscopic transabdominal adrenalectomy (LTA) was performed in 1992 by Ganger [1] and Higashihare [2], the first laparoscopic retroperitoneal adrenalectomy (LRA) was carried out by Walz in 1995 [3], and the first robotic assisted laparoscopic transabdominal adrenalectomy (RALTA) was also conducted by Horgan in 2001 [4]. Although laparoscopic adrenalectomy (LA) is safe and effective for treatment of small- to medium-sized adrenal tumors, however, conventional open adrenalectomy (OA) was set as the gold standard for large adrenal tumor (LAT) because of having higher radicality and lower local recurrence [5, 6]. With addition of experience and development of state-of-the-art techniques, laparoscopic intervention for LAT was found to be feasible as previously examined in a number of cases [7–12]. At present, making comparison between open surgery and minimally invasive surgery for treatment of LAT is great of importance.
Adrenal disorders in pregnancy, labour and postpartum – an overview
Published in Journal of Obstetrics and Gynaecology, 2020
Madhavi Manoharan, Prabha Sinha, Shabnum Sibtain
Treatment of adrenal adenoma includes medical or surgical (unilateral adrenalectomy) therapy after delivery. Surgery is ideally carried out during the second and rarely in the third trimester. The perioperative complication of adrenalectomy varies between 1.7% and 30.7% (Aporowicz et al. 2018). Bilateral adrenelectomy is also associated with a higher complication rate. Left and right adrenelectomy is associated with different risks, due to asymmetry of the abdomen. Left adrenelectomy is associated with injury to surrounding vascular structures like inferior venacava, spleen, splenic vessels and colon. There is an increased risk of metabolic complications and respiratory insufficiency. These women are also at increased risk of wound infection; poor wound healing, deep vein thrombosis and pulmonary embolism due to anti-inflammatory and immune suppressive effects of cortisol. Surgical treatment reduces maternal and fetal morbidity with live births close to 87%; however, it does not reduce the incidence of preterm birth or growth restriction (Choi et al. 2011; Lekarev and New 2011; Toutounchi et al. 2011; Tomaszewski and Dewailly 2012; Sammour et al. 2012; Nassi et al. 2015).
The outcome of childhood adrenocortical carcinoma in Egypt: A model from developing countries
Published in Pediatric Hematology and Oncology, 2020
Wael Zekri, Mahmoud Hammad, Wafaa M. Rashed, Gehad Ahmed, Maged Elshafie, Marwan H. Adly, Yasser Elborai, Badr Abdalla, Hala Taha, Naglaa Elkinaae, Amal Refaat, Alaa Younis, Ahmad S. Alfaar
Surgery: Fourteen patients underwent surgery; 12 patients underwent upfront adrenalectomies, while two patients received chemotherapy first, and then underwent delayed adrenalectomies (Figure 1). Successful complete excisions were achieved in 11 surgeries; another three ended with partial excisions with residuals (Table 2). The procedure used in most patients was an en bloc open adrenalectomy and was performed through a subcostal incision. This approach was used in 12 patients. An extension of the incision (bilateral subcostal incision) was required in one case only. Resection of adjacent organs, including partial liver resection, was performed in two surgeries. Two patients required dissection of their tumors from adjacent structures (complete dissections from the liver, pancreas, kidney, and spleen). No tumor thrombus was found during any of the surgeries. In one case, the tumor was <5 cm in its maximum diameter, allowing for laparoscopic adrenalectomy to be performed.