Clinical therapeutic effectiveness of programmed and anatomical transperitoneal laparoscopic surgery for enormous adrenal tumor(report of 21 cases)
JIN Yongsheng1, DONG Bing2, JIA Junqi1, WANG Feng1, ZHANG Peibo1, LI Yi1, GAO Jixue1
1 Department of Urology, Affiliated Hospital of Yan'an University, Yan'an 716000,China;
2 Department of Infectious Diseases, Affiliated Hospital of Yan'an University
Abstract：Objective： To discuss the feasibility and advantages of the endoscopically programmed and anatomical resection of the enormous adrenal tumor with diameter of ≥6 cm by transabdominal laparoscope, summarize its clinical experience and observe its clinical effectiveness. Methods： The clinical data of 21 patients undergoing the resection of the enormous adrenal tumor by transabdominal laparoscope from April of 2008 to December of 2016 in our department were analyzed, and all the operations were done via the transperitoneal approach by laparoscope following the “9-step method” of programmed and anatomical resection. Results： In the 21 cases of operations, 20 of them have achieved complete success, with one case of patient suffering from adrenal cortical carcinoma whose tumor had serious synechia with surrounding tissue, which was converted to open surgery during operation. The diameter of the tumor ranged from 6 to 12 cm (mean, 8.9 cm), of which 8 cases were to the left and 13 cases to the right. To be specific, there were 15 cases of pheochromocytoma, 2 cases of ganglioneuroma, 2 cases of adrenal cortical carcinoma, 1 case of VHL syndrome concomitant with adrenal pheochromocytoma (the patient’s mother suffering from bilateral adrenal cortical carcinoma), and 1 case of myelolipoma. The operation time ranged from 50 to 190 min (mean, 90.6±35.4 min), the blood loss ranged from 30 to 500 mL (mean, 102.6±19.2 mL), and all operations were not given transfusion. The postoperative hospital stay varied from 5 to 14 days (mean, 7.4±0.6 d). There was no obvious complication in the perioperative period. The postoperative follow-up ranging from 3 to 42 months revealed that there was no tumor recurrence except bone metastasis was found in one case of cortical carcinoma converted to open surgery. Conclusion： The endoscopically programmed and anatomical resection of the enormous adrenal tumor by transabdominal laparoscope has a series of advantages including wider operative field, clear anatomy, precise operation, good vascular exposition, less bleeding, low stimulus to the tumor, short operation time and less complication, etc. This operation method is applicable to the resection of enormous adrenal tumor, which has been proved to be safe and feasible.
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