Posterior retroperitoneal adrenalectomy for metastatic disease: a multi-site Australian series

IF 1.5 4区 医学 Q3 SURGERY
Mark Fenton MBBS, MSc, David Leong MBBS, FRACS, MEPi, Jessica Wong MBBS(Hons), MS, MIPH, FRACS, Paul Zotov MBBS, Stephen Farrell MBBS, FRACS, Julie A Miller MD, FRACS, Mark S Sywak MBBS, MMed Sci (Clin Epi), FRACS, Christine J O'Neill MBBS(Hons), MS, FRACS
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引用次数: 0

Abstract

Background

Posterior retroperitoneoscopic adrenalectomy (PRA) for isolated adrenal metastasis is minimally invasive, may prolong survival and improve quality of life. The current evidence base is scant.

Methods

A multi-site retrospective analysis of all cases of PRA for adrenal metastasis between 2011 and 2023, by four high-volume adrenal surgeons was performed. Perioperative morbidity, disease-free and survival outcomes were reported.

Results

Of 51 patients, 34(67%) male, mean age 63 ± 12 years, mean BMI 28; 49 PRAs for adrenal metastatectomy were completed (one abandoned due to tumour unresectability, one conversion to anterior laparoscopic approach) across 11 hospitals (49% public). Primary tumours included: 11 colorectal, 11 renal, 8 lung, 6 hepatocellular, 4 sarcoma, 3 breast, 2 melanoma, 2 ovarian and 1 each of pancreatic, oesophageal, testicular and prostate cancer. There were 12 synchronous (<6 months) and 39 metachronous (>6 months after primary diagnosis) tumours; 21 (42%) left sided, none bilateral. Mean operative time was 95 ± 34 minutes, mean maximal tumour diameter was 34 mm ± 13 mm and median length of hospitalization 1 ± 1 days. There were 8 (16%) complications; 1 ICU admission, 1 re-admission for pneumonia and 6 Clavien-Dindo grade I complications. There were 10 (20%) mortalities and a median overall survival of 29 months (range 7–123, n = 41). Disease recurred in 15 (40%) patients (n = 37), with a median disease-free interval of 18 months (range 1–68). Port site recurrence occurred in 2 patients, both simultaneously with disseminated metastases.

Conclusion

In carefully selected patients with adrenal metastases, PRA by high-volume adrenal surgeons has minimal morbidity and short hospitalization. Surgery should be considered prior to local ablation.

Abstract Image

针对转移性疾病的腹膜后肾上腺切除术:澳大利亚多地点系列研究。
背景:后腹膜后腔镜肾上腺切除术(PRA)治疗孤立的肾上腺转移瘤是一种微创手术,可延长生存期并改善生活质量。目前的证据基础还很薄弱:方法:对 2011 年至 2023 年期间由四位高水平肾上腺外科医生实施的所有肾上腺转移瘤 PRA 病例进行了多地点回顾性分析。报告了围手术期的发病率、无病生存率和存活率:51名患者中有34名(67%)男性,平均年龄(63±12)岁,平均体重指数(BMI)为28;11家医院(49%为公立医院)完成了49例肾上腺转移瘤切除术PRA(1例因肿瘤无法切除而放弃,1例改用前腹腔镜方法)。原发肿瘤包括11例结直肠癌、11例肾癌、8例肺癌、6例肝癌、4例肉瘤、3例乳腺癌、2例黑色素瘤、2例卵巢癌以及胰腺癌、食道癌、睾丸癌和前列腺癌各1例。其中12例为同步性肿瘤(原发性诊断后6个月);21例(42%)为左侧肿瘤,无双侧肿瘤。平均手术时间为 95 ± 34 分钟,肿瘤最大直径平均为 34 mm ± 13 mm,中位住院时间为 1 ± 1 天。并发症有 8 例(16%);1 例入住重症监护室,1 例因肺炎再次入院,6 例 Clavien-Dindo I 级并发症。死亡人数为 10 人(20%),中位总生存期为 29 个月(7-123 个月不等,n = 41)。15例(40%)患者(37人)疾病复发,中位无病生存期为18个月(1-68个月)。2例患者出现了移植口复发,这2例患者都同时出现了播散性转移:结论:对于经过严格筛选的肾上腺转移患者,由大量肾上腺外科医生实施的PRA具有发病率低、住院时间短的特点。在进行局部消融之前应考虑手术治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
ANZ Journal of Surgery
ANZ Journal of Surgery 医学-外科
CiteScore
2.50
自引率
11.80%
发文量
720
审稿时长
2 months
期刊介绍: ANZ Journal of Surgery is published by Wiley on behalf of the Royal Australasian College of Surgeons to provide a medium for the publication of peer-reviewed original contributions related to clinical practice and/or research in all fields of surgery and related disciplines. It also provides a programme of continuing education for surgeons. All articles are peer-reviewed by at least two researchers expert in the field of the submitted paper.
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