Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.853
Filtrar
1.
Khirurgiia (Mosk) ; (4): 5-10, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32352661

RESUMO

OBJECTIVE: To estimate the results of minimally invasive adrenalectomy in children and compare our data with worldwide results. MATERIAL AND METHODS: There were 65 patients aged from 3 months to 17 years with different organic diseases of adrenal glands. Children have undergone surgery for the period since 2003 to 2018. RESULTS: Incidentalomas accounted 33.8% of all resected tumors. Bilateral lesion was diagnosed in 12% of patients. The largest neoplasm (12 cm) was diagnosed in a 9-year-old child. Intraoperative bleeding occurred in 2 patients. Endoscopic surgery did not require conversion in any case. CONCLUSION: We accumulated unique experience of laparoscopic resection of benign lesions of adrenal glands. Our results are satisfactory and comparable with data of other national and foreign colleagues. Only close collaboration of pediatric surgeons and endocrinologists could lead to successful and safe treatment of these patients. Patients with suspected malignancies should receive treatment at special hospitals with oncological service.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Glândulas Suprarrenais/cirurgia , Adrenalectomia/métodos , Adolescente , Neoplasias das Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/patologia , Criança , Pré-Escolar , Humanos , Achados Incidentais , Lactente , Laparoscopia
2.
Zhonghua Yi Xue Za Zhi ; 100(14): 1087-1090, 2020 Apr 14.
Artigo em Chinês | MEDLINE | ID: mdl-32294873

RESUMO

Objective: To investigate the goal-oriented retroperitoneoscopic adrenalectomy and report the initial experiment. Methods: A total of 102 patients were selected to our clinic experiment, and performed retroperitoneoscopic adrenalectomy with the new method. including adrenal cortex adenoma 76 cases, phaochromocytoma 12 cases, adrenal cyst 6 cases, myelolipoma 4 cases, gangliocytoma 1 case and corticohyperplassia 3 cases. The mean diameter of the tumors was 2.8 cm (0.5-5.8 cm). The operative procedure was briefly described as such, with ultrasound guiding, a needle was punched percutaneously up to the adrenal mass or the renal upper pole from lateral to posterior axillary line just below the inferior border of the 12th rib. labeled the pathway of the needle with methylene blue. Along the way of the needle, a 12 mm port was introduced into the retroperitoneal space with closed method, and the laparoscope with a working tunnel was introduced to make a tunnel along the label up to the adrenal for finally removing it. Additional port should be used when it was needed in the procedure. Results: The procedures of all patients were successful, and 10 patients were performed with only one port, 81 patients with two ports, 11 patients with three ports. The operative duration was 49 (31-115) min, the average blood loss was 38 (0-260) ml. There was no transition to open surgery and no perioperative complications. The length of postoperative hospital stay was 4.1 d (2-7 d). 98 patients were available for follow-up of 16.5 months (1-38 months), no complication was found. Conclusions: The new method of retroperitoneoscopic adrenalectomy is feasible and safe for renal masses, and compared to the conventional method, it may be less trauma to the abdominal wall and retropertoneal tissue, and it was also better on cosmetics.


Assuntos
Neoplasias das Glândulas Suprarrenais , Adrenalectomia , Neoplasias das Glândulas Suprarrenais/cirurgia , Objetivos , Humanos , Laparoscopia , Espaço Retroperitoneal
3.
J Comput Assist Tomogr ; 44(3): 419-425, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32345808

RESUMO

PURPOSE: The aims of the study were to assess the typical and atypical radiologic features of pathologically proven adrenal adenomas and to determine the relationship between the radiologic and histopathologic classification. METHODS: We retrospectively studied 156 pathologically proven adrenal adenomas in 154 patients from our institutional databases who have computed tomography (CT) and/or magnetic resonance imaging (MRI) examinations before intervention. We determined the histopathologic diagnosis (typical or atypical) using Weiss scoring and classified the adenomas radiologically into typical, atypical, or indeterminate based on lesion size, precontrast CT attenuation, absolute percentage washout, calcification, and necrosis. The κ statistic was used to assess the agreement between radiologists. The Fisher exact test was used to compare the radiologic and pathological classifications. RESULTS: In consensus, there were 83 typical, 42 atypical, and 31 indeterminate adrenal lesions. Logistic regression model showed that radiologically atypical adenoma was significantly associated with larger size, lobulated shape, higher unenhanced CT attenuation, heterogeneous appearance, nonfunctioning status, absolute percentage washout of less than 60%, and a signal intensity index of less than 16.5%.Pathologically, 147 adenomas were pathologically typical (Weiss 0), and 9 adenomas were pathologically atypical (Weiss 1-2). Radiologically, there was substantial agreement between both readers, with Cohen κ at 0.71. Approximately 98% of radiologically typical adenomas were pathologically typical. Only 17% of radiologically atypical adenomas were pathologically atypical. All radiologically indeterminate adenomas were pathologically typical. However, some of the radiologically indeterminate and typical adenomas still had an atypical component on pathologic analysis, such as necrosis, nuclear atypia, or oncocytic features. CONCLUSIONS: Radiologically atypical lesion was significantly associated with larger size and higher unenhanced CT attenuation. Approximately 27% of the cases demonstrated atypical features on imaging. Most radiologically atypical adrenal adenomas are pathologically typical.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/patologia , Cuidados Pré-Operatórios/métodos , Tomografia Computadorizada por Raios X/métodos , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adolescente , Neoplasias das Glândulas Suprarrenais/cirurgia , Glândulas Suprarrenais/diagnóstico por imagem , Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
4.
Clin Ter ; 171(2): e178-e182, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32141491

RESUMO

BACKGROUND: Laparoscopic adrenalectomy (LA) has become the treatment of choice for benign adrenal lesions. Lateral Transperitoneal Laparoscopic Adrenalectomy (LTLA) is considered the gold standard. The number of LTLAs a surgeon must perform, in order to complete his learning curve, is not well defined in Literature. Moreover, the few papers dealing with the learning curve for LTLAs show controversial results and consider different evaluation parameters. METHODS: The systematic review has been carried out according to PRISMA statement. The literature search included PubMed and Scopus database. Hand searching of reference lists of previous review articles and relevant studies was also performed. The search string was "learning curve AND laparoscopic adrenalectomy". RESULTS: A total of 9 papers met the inclusion criteria out of 94 non duplicate citations. The aim of this systematic review is to provide a multidimensional evaluation by bringing into focus evaluation parameters of surgical performance, (operative time, intraoperative complications, conversion rate and blood loss), factors related to patient's pathology (side, size, adrenal pathology) and surgeon-specific properties. CONCLUSIONS: Operative time, intraoperative bleeding, intraoperative complications and conversion rate are the main parameters that have been considered for the achievement of learning curve, and for each there are discrepancies, mainly due to the relative rarity of adrenal tumors, and so for difficulties in obtaining approper analysis that could establish an effective learning curve. So, further evaluations in larger experience are needed.


Assuntos
Adrenalectomia/educação , Laparoscopia/educação , Curva de Aprendizado , Neoplasias das Glândulas Suprarrenais/cirurgia , Humanos , Complicações Intraoperatórias , Laparoscopia/métodos , Tempo de Internação , Duração da Cirurgia
5.
Medwave ; 20(2): e7830, 2020 Mar 04.
Artigo em Espanhol | MEDLINE | ID: mdl-32191683

RESUMO

Pheochromocytomas and paragangliomas are rare neuroendocrine tumors, characterized by a high morbidity rate due to catecholamine excess. These high levels are independent of physiologic stressors. For the diagnosis, a biochemical workup is paramount. The most widely used are plasma-free metanephrines and urinary fractionated metanephrines. Imaging studies should be initiated once the biochemical diagnosis is established. Evaluation of the patient with pheochromocytomas and paragangliomas must be done taking into account the leading causes of perioperative morbidity and mortality. The two primary interventions that have reduced perioperative mortality are alpha-adrenergic blockade and intravascular volume normalization. Another significant advance has been the establishment of laparoscopic surgery as the gold standard for the surgical approach. No anesthetic technique has been found to be superior to another. Intraoperative hemodynamic instability has been correlated with poorer outcomes; thus one of the main intraoperative goals is maintaining hemodynamic stability. Lower morbidity and almost zero mortality rates due to preoperative and intraoperative management improvements have led to a focus on the immediate and long-term postoperative care. Anual lifelong follow-up is recommended to detect recurrent disease.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Paraganglioma/cirurgia , Feocromocitoma/cirurgia , Humanos , Laparoscopia
6.
Am Surg ; 86(2): 127-133, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32167055

RESUMO

Adrenal neuroblastoma (NB) is a relatively common malignancy in children. The Surveillance, Epidemiology, and End Results database was used to present demographic data and a survival analysis with the aim of making tumor management better. The Surveillance, Epidemiology, and End Results database was used to search pediatric patients (age ≤16 years) with NB from 2004 to 2013. The Kaplan-Meier method was used to calculate the overall survival. And, we used Cox regression analysis to determine hazard ratios for prognostic variables. Independent prognostic factors were selected into the nomogram to predict individual's three-, five-, and seven-year overall survival. The study included a total of 1870 pediatric patients with NB in our cohort. Overall, three-, five-, and seven-year survival rates for adrenal NB were 0.777, 0.701, and 0.665, respectively, whereas the rates for nonadrenal NB were 0.891, 0.859, and 0.832, respectively. The multivariate analysis identified age >1 year, no complete resection (CR)/CR, radiation, and regional/distant metastasis as independent predictors of mortality for adrenal NB. Concordance index of the nomogram was 0.665 (95% confidence interval, 0.627-0.703). Pediatric patients with adrenal NB have significantly worse survival than those with nonadrenal NB. Adrenal NB with age <1 year, treated with surgery, no radiation, and localized tumor leads to a better survival. There was no survival difference for patients to receive CR and no CR.


Assuntos
Neoplasias das Glândulas Suprarrenais/mortalidade , Neuroblastoma/mortalidade , Adolescente , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Masculino , Neuroblastoma/patologia , Neuroblastoma/cirurgia , Nomogramas , Prognóstico , Análise de Regressão , Programa de SEER/estatística & dados numéricos , Análise de Sobrevida , Taxa de Sobrevida , Fatores de Tempo
7.
Chirurgia (Bucur) ; 115(1): 80-88, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32155402

RESUMO

Adrenalectomy is nowadays a procedure routinely performed by minimally invasive surgery. In this article we aim to describe in depth our technique for laparoscopic and robotic left and right adrenalectomies, by using four cases and discussing the advantages and disadvantages of each technique.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/métodos , Laparoscopia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias das Glândulas Suprarrenais/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Resultado do Tratamento
8.
Ann Afr Med ; 19(1): 26-30, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32174612

RESUMO

Introduction: The aim of this study was to present our 20-year experience regarding open adrenalectomy (OA) during laparoscopic era in a developing country Turkey. Materials and Methods: A retrospective and descriptive study of patients with adrenal mass undergoing OA in the surgery department of our hospital, between January 1993 and January 2013, was carried out. All operations were performed by two surgeons. Results: Ninety patients who underwent OA in our clinic were reviewed retrospectively. The mean number of adrenal operations per month during this period was 0.38 ± 0.12. The patient included 35 men (38.8%) and 55 women (61.2%), with a mean age of 46.4 ± 17 years. The mean body mass index was 28.4 ± 5.25, and the mean American Society of Anesthesiologists score was 2.6 ± 0.57. The mean operative time was 88 ± 27 min. The mean maximum diameter of all the lesions was 4.8 ± 1.3 cm (range: 1.2-21 cm). The mean blood loss was 118 ± 23 ml during the operations. Postoperative complications were observed in four patients (5.5%). There was no mortality. The length of hospital stay was 6.2 ± 2.1 days. The most frequent type of the histological type was benign adenoma (48.8%). Conclusion: OA in a developing country is a safe method as an alternative for laparoscopic adrenalectomy which has a difficult learning curve.


Assuntos
Doenças das Glândulas Suprarrenais/cirurgia , Neoplasias das Glândulas Suprarrenais/cirurgia , Glândulas Suprarrenais/cirurgia , Adrenalectomia/métodos , Doenças das Glândulas Suprarrenais/diagnóstico , Doenças das Glândulas Suprarrenais/epidemiologia , Neoplasias das Glândulas Suprarrenais/epidemiologia , Neoplasias das Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/patologia , Adrenalectomia/estatística & dados numéricos , Adulto , Idoso , Perda Sanguínea Cirúrgica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Turquia/epidemiologia
9.
Medicine (Baltimore) ; 99(7): e19104, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049819

RESUMO

Hemodynamic stability is one of the most critical aspects of adrenal surgery for pheochromocytoma. Few articles have evaluated the hemodynamic status of patients undergoing posterior retroperitoneal adrenalectomy (PRA) for pheochromocytoma. The aim of this study is to compare the intraoperative hemodynamic parameters between lateral transperitoneal adrenalectomy (TPA) and PRA in this groups of patients.This report describes a retrospective study of 53 pheochromocytoma patients who underwent endoscopic adrenalectomy via transperitoneal (22 patients) or posterior retroperitoneal (31 patients) approaches from January 2008 to March 2015. Data from these patients were compared to investigate the differences in hemodynamic parameters between the 2 approaches.Clinical parameters at presentation were similar between the 2 groups, except for tumor size, which was larger in the TPA group. The PRA group is associated with reduced operative time, blood loss, and length of hospital stay compared to TPA even after adjusting for the tumor size. There was greater BP fluctuations and higher maximum systolic and diastolic blood pressure (BP) within the TPA group compared to PRA during univariate analysis. This was however not significant after adjusting for tumor size. There was no difference in the intraoperative inotropic support requirement between the 2 groups.PRA is associated with stable intraoperative hemodynamic status, as well as favorable perioperative outcomes compared to TPA in patients with small pheochromocytomas.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/métodos , Feocromocitoma/cirurgia , Neoplasias das Glândulas Suprarrenais/patologia , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Pressão Sanguínea , Estudos de Casos e Controles , Endoscopia , Humanos , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Duração da Cirurgia , Feocromocitoma/patologia , Espaço Retroperitoneal/cirurgia , Estudos Retrospectivos
10.
Orv Hetil ; 161(2): 75-79, 2020 Jan.
Artigo em Húngaro | MEDLINE | ID: mdl-31902232

RESUMO

The authors present the case of a multiplex endocrine neoplasia type 2A (MEN2A). The 55-year-old woman underwent detailed examinations for abdominal complaints. Bilateral adrenal masses and thyroid nodular goiter were found. Based on metanephrine excretion and MIBG imaging, bilateral phaeochromocytomas were diagnosed. The thyroid nodules were confirmed by thyroidectomy as bilateral medullary thyroid carcinoma. Asymptomatic primary hyperparathyroidism was also detected. Laparoscopic adrenalectomy and parathyroid adenoma removal were performed. Based on family history and the characteristic clinical presentation, MEN2A syndrome was confirmed by genetic testing. During genetic screening of first-degree relatives, the patient's 25-year-old daughter was shown to be a gene carrier. Preventive thyroidectomy was performed and histology proved multifocal medullary thyroid cancer. In addition to the importance of genetic testing, the authors emphasize the guideline-based, but individualized approach to patients with suspected MEN2A syndrome. Orv Hetil. 2020; 161(2): 75-79.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia , Neoplasia Endócrina Múltipla Tipo 2a/diagnóstico , Feocromocitoma , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/cirurgia , 3-Iodobenzilguanidina , Neoplasias das Glândulas Suprarrenais/patologia , Adulto , Feminino , Bócio Nodular , Humanos , Metanefrina , Pessoa de Meia-Idade , Neoplasia Endócrina Múltipla Tipo 2a/genética , Neoplasias das Paratireoides , Proteínas Ribossômicas , Neoplasias da Glândula Tireoide/genética , Nódulo da Glândula Tireoide/patologia , Tireoidectomia
12.
BMC Surg ; 20(1): 12, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31931809

RESUMO

BACKGROUND: To compare the perioperative outcomes and safety of transperitoneal laparoscopic adrenalectomy with those of retroperitoneal laparoscopic adrenalectomy for patients with pheochromocytoma. METHODS: We searched PubMed, EMBASE and the Cochrane Central Register for studies from 1999 to 2019 to assess the perioperative outcomes and safety of transperitoneal laparoscopic adrenalectomy and the retroperitoneal approach for laparoscopic adrenalectomy in patients with pheochromocytoma. After data extraction and quality assessments, we used RevMan 5.2 to pool the data. RESULTS: Four retrospective studies were obtained in our meta-analysis. Patients who underwent retroperitoneal laparoscopic adrenalectomy were associated with shorter operative time (WMD: 34.91, 95% CI: 27.02 to 42.80, I2 = 15%; p < 0.01), less intraoperative blood loss (WMD: 139.32, 95% CI: 125.38 to 153.26, I2 = 0, p < 0.01), and a shorter hospital stay (WMD: 2, 95% CI: 1.18 to 2.82, I2 = 82%, p < 0.01) than patients who underwent transperitoneal laparoscopic adrenalectomy. No significant differences were found in the complication rate (OR: 1.58, 95% CI: 0.58 to 4.33, I2 = 0; p = 0.38) or in the incidence of hemodynamic crisis (OR: 0.74, 95% CI: 0.19 to 2.94, p = 0.67) between the two groups. CONCLUSION: Retroperitoneal laparoscopic adrenalectomy could achieve better perioperative outcomes than the transperitoneal approach for patients with pheochromocytoma.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/métodos , Laparoscopia/métodos , Feocromocitoma/cirurgia , Perda Sanguínea Cirúrgica , Humanos , Tempo de Internação , Duração da Cirurgia , Espaço Retroperitoneal/cirurgia
13.
Int J Clin Oncol ; 25(1): 126-134, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31471786

RESUMO

BACKGROUND: Because of the small numbers of cases in single centers, the indications for and survival benefits of adrenalectomy for adrenal metastasis remain unclear. We evaluated the outcomes of laparoscopic adrenalectomy for patients with adrenal metastasis. METHODS: We retrospectively analyzed the records of 67 patients who underwent laparoscopic adrenalectomy for metastatic disease from 2003 to 2017 at 11 hospitals. Associations of clinical, surgical, and pathologic features with overall survival (OS) and positive surgical margins were evaluated using univariate and multivariate Cox regression analyses and univariate logistic regression analysis. RESULTS: Lung cancer (30%) and renal cell carcinoma (30%) were the most common primary tumor types. Intraoperative complications were observed in seven patients (10%) and postoperative complications in seven (10%). The surgical margin was positive in 10 patients (15%). The median OS was 3.8 years. Univariate analysis showed that the tumor size, episodes of extra-adrenal metastasis before adrenalectomy, extra-adrenal metastasis at the time of adrenalectomy, and positive surgical margins were significantly associated with shorter OS (p = 0.022, p = 0.005, p < 0.001, and p = 0.022, respectively). Multivariate analysis showed that extra-adrenal metastasis at the time of adrenalectomy and positive surgical margins remained statistically significant (p = 0.022 and p = 0.049, respectively). In the univariate analysis, the tumor size was significantly associated with positive surgical margins (p = 0.039). CONCLUSIONS: Laparoscopic adrenalectomy for adrenal metastasis can be safely performed in selected patients, and patients with isolated adrenal metastasis and negative surgical margins seem to have more favorable outcomes.


Assuntos
Neoplasias das Glândulas Suprarrenais/secundário , Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/métodos , Laparoscopia/métodos , Neoplasias das Glândulas Suprarrenais/mortalidade , Idoso , Carcinoma de Células Renais/patologia , Estudos de Viabilidade , Feminino , Humanos , Japão , Neoplasias Renais/patologia , Neoplasias Pulmonares/patologia , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Seleção de Pacientes , Estudos Retrospectivos , Resultado do Tratamento
14.
Urology ; 135: 71-75, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31195014

RESUMO

OBJECTIVE: To summarize the clinical characteristics and surgical management of adrenal teratoma in adults. PATIENTS AND METHODS: We retrospectively reviewed 14 patients with adrenal teratoma from January 2002 to June 2017, at 2 large centers in China and performed a systematic review of 39 patients from our series and published literatures. The clinicopathological characteristics, imaging features, surgical management and outcomes of this rare disease were analyzed. RESULTS: Our series includes 12 females and 2 males with the median age of 35. Seven patients were treated by open adrenalectomy (OA) and 7 by laparoscopic adrenalectomy (LA) without perioperative complications. All patients were alive without recurrence or canceration over a mean follow-up of 77.1 months. In the systemic review, the male-female ratio was nearly 1:3, with a median age of 29 years. Mean tumor size was 9.4 cm and the distribution was almost the same between left and right side (53.8% vs 46.2%). The most common symptoms were flank or abdominal pain (46.2%), whereas 53.8% patients were asymptomatic. Tumors were often cystic (63.9%) with intratumoral fat (91.7%) and calcifications (80.6%). All patients underwent surgery including 17 (43.6%) OA and 22 (56.4%) minimally invasive surgery. All tumors were pathologically confirmed mature teratoma except for one. CONCLUSION: Adrenal teratoma is an extremely rare entity, frequently found to be large, benign and cystic. The patient's prognosis is generally good. As for its large volume, OA is the first choice for teratoma in most cases, while the LA can be an option in the small one.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Glândulas Suprarrenais/patologia , Doenças Assintomáticas/terapia , Doenças Raras/cirurgia , Teratoma/cirurgia , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/cirurgia , Adrenalectomia , Adulto , China , Feminino , Seguimentos , Humanos , Laparoscopia , Masculino , Prognóstico , Doenças Raras/diagnóstico , Doenças Raras/patologia , Estudos Retrospectivos , Teratoma/diagnóstico , Teratoma/patologia , Resultado do Tratamento
15.
Surgery ; 167(1): 204-210, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31542169

RESUMO

BACKGROUND: Obese patients may have unrecognized primary aldosteronism due to high rates of concomitant hypertension. We hypothesized that obesity impacts the diagnosis and management of patients with primary aldosteronism. METHODS: We conducted a retrospective analysis of all primary aldosteronism patients (n = 418) who underwent adrenal vein sampling (1997-2017). Patients were classified by body mass index as obese (body mass index ≥35) or nonobese (body mass index <35) and diagnostic evaluation was compared between groups. Within the operative cohort (n = 285), primary outcomes were changes in both blood pressure and antihypertensive medications after adrenalectomy. Secondary outcome was clinical resolution by Primary Aldosteronism Surgery Outcomes criteria. RESULTS: Thirty-five percent of patients were obese. Obese patients were more likely to be male (67.8% vs 56.1%, P = .025), somewhat younger (51.5 vs 54.4 years old, P < .012), and require more preoperative antihypertensive medications (6.7 vs 5.7, P = .04) than nonobese patients. Obese patients had lesser rates of radiologic evidence of adrenal tumors (68.4 vs 77.9%, P = .038) despite similar rates of lateralization on adrenal vein sampling. In the operative subset, obese patients had somewhat smaller tumors on final pathology (1.1 vs 1.5 cm, P = .014) but similar rates of complete and partial clinical resolution (P = 1.000). CONCLUSION: Obese primary aldosteronism patients have lesser rates of localization by imaging, likely due to smaller tumor size, however, experience similar benefit from adrenalectomy.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Adrenalectomia , Anti-Hipertensivos/administração & dosagem , Hiperaldosteronismo/diagnóstico , Hipertensão/terapia , Obesidade/complicações , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/epidemiologia , Neoplasias das Glândulas Suprarrenais/cirurgia , Glândulas Suprarrenais/diagnóstico por imagem , Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/cirurgia , Adulto , Fatores Etários , Idoso , Pressão Sanguínea/efeitos dos fármacos , Índice de Massa Corporal , Feminino , Humanos , Hiperaldosteronismo/epidemiologia , Hiperaldosteronismo/etiologia , Hiperaldosteronismo/cirurgia , Hipertensão/etiologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Resultado do Tratamento
16.
Surgery ; 167(1): 250-256, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31543324

RESUMO

BACKGROUND: Laparoscopic adrenalectomy can be performed using a transabdominal or posterior retroperitoneal approach. Choosing the optimal approach can be challenging. METHODS: Using data from the Collaborative Endocrine Surgery Quality Improvement Program (2014-2018), baseline patient characteristics and outcomes were compared with bivariate methods; univariate and multivariate analyses were used to estimate the association between operative approach and complication risk. RESULTS: Among 833 patients, 35.3% underwent posterior retroperitoneal. Median age was 54 years. Patients undergoing posterior retroperitoneal had lesser rates of body mass index >40 (9.2% vs 17.4%, P = .001), smaller nodules (median 2.4 vs 3.2 cm, P < .001), and more commonly right-sided nodules (46.6% vs 36.9%, P = .02). Posterior retroperitoneal was associated with a lesser rate of conversion to an open procedure (0.7% vs 4.1%, P = .004), less complications (3.1% vs 8.7%, P = .002), and shorter hospital stay (≤48 h: 92.2% vs 76.6%, P < .001), but a greater rate of capsular disruption (12.6% vs 7.6%, P = .02). For posterior retroperitoneal cases with capsular disruption, median nodule size was 2.2 cm, and 16.2% were metastatic tumors. After multivariate adjustment, posterior retroperitoneal was 2.2 times as likely to result in capsular disruption as transabdominal (95% confidence interval, 1.04-4.79, P = .04). CONCLUSION: This study revealed a greater rate for capsular disruption during posterior retroperitoneal even for small tumors. Our findings from the Collaborative Endocrine Surgery Quality Improvement Program (2014-2018) suggests that posterior retroperitoneal should be used selectively, especially when a malignancy is suspected.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/métodos , Laparoscopia/métodos , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Adrenalectomia/efeitos adversos , Adulto , Idoso , Conversão para Cirurgia Aberta/estatística & dados numéricos , Feminino , Humanos , Laparoscopia/efeitos adversos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Melhoria de Qualidade , Espaço Retroperitoneal/cirurgia , Estudos Retrospectivos , Medição de Risco , Cirurgiões/normas , Resultado do Tratamento
17.
Surgery ; 167(1): 241-249, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31653489

RESUMO

BACKGROUND: Safe performance of laparoscopic transabdominal adrenalectomy requires the application of a complex body of knowledge and skills, which are difficult to define, teach, and measure. This qualitative study aims to characterize expert behaviors, decisions, and other cognitive processes required to perform laparoscopic transabdominal adrenalectomy. METHOD: Hierarchical and cognitive task analyses for right and left laparoscopic transabdominal adrenalectomy were performed using semi-structured interviews and field observations of experts. Verbal data was supplemented with published literature, coded and thematically analyzed using constructivist grounded-theory by 2 independent reviewers. RESULTS: A conceptual framework was synthesized. Sixty-eight tasks, 46 cognitive behaviors, and 52 potential errors were identified and categorized into 8 procedural steps and 8 fundamental principles: anticipation, exposure, teamwork or communication, physiology, dissection techniques, oncologic margins, tactical modification, and error recovery. Experts emphasized the importance of creating a 3-dimensional mental model of the anatomy or pathology (eg, aberrant vessels, tumor location) that is consistently fine-tuned throughout the operation, with conscious awareness of danger zones (eg, medial arc). Despite variations in dissection techniques, experts highlighted 2 themes: macrodissection and microdissection, with emphasis on nonlinear motions and effective transitions between the 2 when appropriate. CONCLUSION: This study defines behaviors and competencies that are essential to performing laparoscopic transabdominal adrenalectomy effectively and safely.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/normas , Competência Clínica/normas , Laparoscopia/normas , Cirurgiões/psicologia , Adulto , Atitude do Pessoal de Saúde , Tomada de Decisão Clínica , Cognição , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Melhoria de Qualidade , Cirurgiões/normas
18.
Am J Case Rep ; 20: 1817-1820, 2019 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-31806861

RESUMO

BACKGROUND Ganglioneuroma is a rare benign sympathetic chain neoplasm which rarely arise from the adrenal gland in adults and exceedingly rare for ganglioneuroma to arise from different origins in the same patient. We present a rare case of retroperitoneal ganglioneuroma concurring with an adrenal ganglioneuroma in an adult patient. CASE REPORT A 17-year-old healthy male underwent computed tomography (CT) scan after road traffic accident where he was found to have a left adrenal homogeneous hypovascular lesion with another retroperitoneal lesion seen within the right para-colic gutter with similar radiological features. Successful surgical resection was obtained, and histological diagnosis of both lesions was benign ganglioneuroma. CONCLUSIONS Adrenal and extra-adrenal ganglioneuroma can, although rare, concur together. Key findings are the similar radiological appearance of the lesions with typical hypovascular progressive pattern of enhancement. Appropriate pre-surgical diagnosis can aid to proper management since ganglioneuroma needs wide surgical resection due to its high chance of recurrence.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Ganglioneuroma/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Retroperitoneais/cirurgia , Adolescente , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Ganglioneuroma/diagnóstico por imagem , Humanos , Masculino , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Retroperitoneais/diagnóstico por imagem , Tomografia Computadorizada por Raios X
19.
BMC Surg ; 19(1): 198, 2019 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-31864326

RESUMO

BACKGROUND: This retrospective clinical study is to evaluate the safety and efficiency of two different approaches in retroperitoneal laparoscopic adrenalectomy and provide experience and basis for the treatment of adrenal tumors through retroperitoneal approach. METHODS: From July 2015 to February 2018, 112 patients with adrenal lesions underwent retroperitoneal laparoscopic adrenalectomy (RLA) using a 3-port method. Among them, 56 patients underwent RLA via the extra perinephric fat approach (EPFA), 56 patients underwent RLA via the intra perinephric fat approach (IPFA). Clinical data, including preoperative, operative and postoperative management were recorded. RESULTS: All surgeries were successfully completed, and there was no single patient who died during these surgeries. There was no statistically significant difference between the two groups in blood loss, postoperative complications, vena cava injury, renal cortex injury, peripheral organ injury, and post operation hospital stay. Peritoneum injury occurred more frequently in the EPFA group when compared with the IPEA group (p = 0.042). The average surgery time of the IPEA group is significantly shorter when compared with that of the EPEA group (p < 0.001). Due to serious saponification of the perinephric fat and heavy adhesion to renal fascia, three cases in IPFA group were converted to the EPFA surgery. CONCLUSION: RLA is a safe and effective procedure both via extra perinephric fat and intra perinephric fat approaches. IPEA is superior to EPEA in terms of peritoneal injury and duration. The choice may mainly depend on the experience of the surgeon, the characteristics of the adrenal tumor and the nature of the perinephric fat.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/métodos , Laparoscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Adrenalectomia/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Rim/patologia , Laparoscopia/efeitos adversos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Peritônio/patologia , Complicações Pós-Operatórias/cirurgia , Espaço Retroperitoneal , Estudos Retrospectivos , Resultado do Tratamento , Lesões do Sistema Vascular/epidemiologia , Lesões do Sistema Vascular/cirurgia
20.
BMJ Case Rep ; 12(12)2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31862816

RESUMO

Adrenal myelolipomas represent a benign neoplasm with known associations with many chronic diseases, 21-hydroxylase deficiency and cancer. However, the aetiology of adrenal myelolipomas remains unknown. Here, we present a case of a patient with image-proven bilateral adrenal haemorrhages caused by trauma with the subsequent development of bilateral adrenal myelolipomas several years later. Resection and pathological analysis of left adrenal gland confirmed the presence of multiple adrenal myelolipomas. Our case strongly suggests that trauma was the inciting event that led to the formation of these lesions.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Glândulas Suprarrenais/lesões , Hemorragia , Traumatismo Múltiplo , Mielolipoma/diagnóstico , Acidentes de Trânsito , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Mielolipoma/diagnóstico por imagem , Mielolipoma/cirurgia , Robótica , Tomografia Computadorizada por Raios X
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA