Retroperitoneal Laparoscopic Adrenalectomy With Transient Renal Artery Occlusion for Large Adrenal Tumors (≥8 Cm)

J Surg Oncol. 2018 Apr;117(5):1066-1072. doi: 10.1002/jso.25002. Epub 2018 Feb 15.

Abstract

Objectives: To analyze our experience in retroperitoneal laparoscopic adrenalectomy (RLA) with transient renal artery occlusion for large adrenal tumors (≥8 cm) and to explore the safety and feasibility of this surgical procedure.

Methods: A retrospective cohort study was conducted with a surgical data review of 18 patients with large adrenal tumors who underwent RLA with transient renal artery occlusion in our hospital.

Results: Eighteen patients were treated by RLA with transient occlusion of the renal artery, and none were converted to open adrenalectomy. The renal artery occlusion time, operative time, estimated blood loss, perirenal drainage time, postoperative hospital stay, and postoperative drainage were 7.6 ± 1.0 min, 176.3 ± 49.7 min, 247.2 ± 274.1 mL, 4.1 ± 1.02 days, 6.3 ± 1.4 days, and 73.6 ± 47.9 mL, respectively. No severe complications occurred, with the exception of hemodynamic instability in one patient with a pheochromocytoma and one transfusion during the operation. Only one case of adrenal crisis occurred postoperatively. Pathological examination revealed 9 cases of pheochromocytoma, 6 cases of adrenal myelolipoma, 1 case of adrenal ganglioneuroma, 1 case of hygromata, and 1 case of adrenal teratoma. No recurrence or evidence of metastasis was observed during the 7-to-30-month follow-up period.

Conclusion: RLA with transient renal artery occlusion is a feasible, effective, and safe treatment for large adrenal tumors (≥8 cm).

Keywords: adrenal tumor; renal artery occlusion; retroperitoneal laparoscopic adrenalectomy.

MeSH terms

  • Adrenal Gland Neoplasms / pathology
  • Adrenal Gland Neoplasms / surgery*
  • Adrenalectomy / methods*
  • Adult
  • Aged
  • Female
  • Follow-Up Studies
  • Humans
  • Laparoscopy / methods*
  • Length of Stay
  • Male
  • Middle Aged
  • Pheochromocytoma / pathology
  • Pheochromocytoma / surgery*
  • Renal Artery Obstruction / complications*
  • Retroperitoneal Space / pathology
  • Retroperitoneal Space / surgery*
  • Retrospective Studies
  • Treatment Outcome