SURGERY OF PRIMARY AND UNILATERAL ADRENAL -TUMORS - RESULTS IN 154 PATIENTS

Surgical resection of adrenal neoplasias with endocrine activity is pr incipally indicated. In adrenal neoplasias without endocrine activity, surgical removal is indicated in relation to tumor size. Surgical acc ess and extent of resection are the major problems related to adrenal surgery. From 1980 to 1996, in 154 patients (62 m, 92 f) primary and u nilateral adrenal tumors (139 benign, 15 malign) were resected. 93 res ections were performed transperitoneally, 13 extraperitoneally, and 48 retroperitoneoscopically. Subtotal adrenal resections were performed in 23 benign tumors smaller than 4 cm. Perioperative lethality was 0 % , morbidity was 31,8 %. Malignancy was correlated to tumor size: In 11 4 tumors smaller than 5 cm, no malign neoplasia was found, whereas in 40 tumors larger than 5 cm, 15 specimen were malign. Operating time of the retroperitoneoscopic method was significantly longer than of open procedures (p<0,05). Postoperative analgetic medication was significa ntly reduced after endoscopic surgery compared to transperitoneal or e xtraperitoneal surgery (p<0,0001). No tumor recurrences occurred after subtotal adrenal resections (mean follow up: 5,7 [1,3 years]). In pat ients with adrenal carcinomas, 5-year-survival was approximately 15 %. In adrenal neoplasias smaller than 5 cm, malignancy is extremely rare . Therefore, less aggressive surgery with a lower morbidity (extraperi toneal approach) and reduced postoperative pain (retroperitoneoscopic approach) including function preserving resection is indicated in thes e lesions. Due to the high incidence of malignancy, adrenal tumors lar ger than 5 cm should principally be treated by conventional transperit oneal surgery.