Adrenal masses in neoplastic patients - The role of laparoscopic procedure

Background: The incidence of complications resulting from fine-needle biops y of adrenal masses in patients already treated by radical procedures for p rimitive neoplasms of the lungs and kidneys substantiates our opinion conce rning laparoscopy as both a diagnostic and therapeutic procedure. Methods: We performed 70 laparoscopic adrenalectomies from April 1995 to De cember 1999. In five patients, the adrenal mass appeared at follow-up evalu ation in patients submitted to surgery for a spinocellular lung cancer. One patient underwent surgery for renal adenocarcinoma. In two patients, the a drenal mass was present already at the time primitive lung tumor was diagno sed, so adrenalectomy was performed at the first lung surgery in one patien t and 2 weeks before lung surgery in the other patient. All the patients we re placed in a lateral position for a transperitoneal approach. Right adren al masses were present in seven patients, whereas one patient had an adrena l mass in a left location. Results: No laparotomy was required. The average surgical time was 160 min. (range, 115-120 min). No morbility or mortality occurred, and the average hospital stay was 4 days (range, 3-11 days). All the patients had a complet e removal of their masses, which averaged 4.5 cm (range, 2.5-6 cm) in size. Histology confirmed the metastatic origin of the mass in five of seven pat ients with primary lung cancer, and in one patient with previous kidney can cer. At this writing, three patients were disease free and still alive resp ectively at 3, 5, and 18 months. Three patients died of brain metastases re spectively at 16, 36, and 36 months. An adenoma was proved in the other two cases. Conclusions: Laparoscopic adrenalectomy allows us to propose a much more ag gressive approach to adrenal masses demonstrated at follow-up evaluation or in patients with primary lung or kidney cancer and no masses at other loca tions. Nevertheless a much larger study is required for definitive conclusi ons on a survival rate. We believe that a mini-invasive procedure such as l aparoscopy may allow us to replace a rational surgical approach with a more certain pathologic diagnosis.