PRACTICAL ASPECTS OF LAPAROSCOPIC ADRENALECTOMY IN CHILDREN WITH BENIGN ADRENAL TUMORS



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Abstract

Introduction. Despite of almost 30-year world experience in mini-invasive adrenalectomy in non-oncologic pediatric patients, this issue remains not fully understood and systematized in the domestic literature. Material and methods. Our work is based on 67 laparoscopic adrenalectomies performed in 65 patients, aged from 3 months to 17 years, with predominantly benign neoplasms. Despite of a thorough preoperative examination of each patient, we met malignant neoplasms in 7 cases: 4 - adrenocortical cancer and 3 - neuroblastomas (further they were treated by oncologists). Location of the neoplasms was as follows: right-sided - 31, left-sided - 26, bilateral - 8 (6 patients out of them had bilateral simultaneous removal). Average size of the removed formations was 4.65 ± 1.29 cm (maximum 12 cm). Results and discussion. The vast majority of detected adrenal neoplasms are removed. Exceptions may be neoplasms less than 4 cm in diameter with the native density less than 10 HU by computed tomography; however, they should be actively monitored by specialists. If a malignant process is suspected, patients should be examined more thoroughly and should be treated in specialized hospitals. Nowadays, a minimally invasive and safe surgical treatment of neoplasms in the adrenal glands depends on the experience and trainings of surgeons and anesthesiologists, as well as on the equipment in the operating room. A key to the successful treatment of patients with benign adrenal neoplasms is a specific attention to curative peculiarities in such patients as well as an adequate sequence of actions during laparoscopic adrenalectomy in its main stage, namely, ligation of the central adrenal vein.

About the authors

I. V. Poddubny

A.I. Yevdokimov Moscow State University of Medicine and Dentistry; Morozovskaya Children City Hospital, Healthcare Department of Moscow

Author for correspondence.
Email: noemail@neicon.ru
Russian Federation

R. S. Oganesyan

Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology

Email: raisaoganesyan@gmail.com
ORCID iD: 0000-0002-1698-2956
Russian Federation

K. N. Tolstov

A.I. Yevdokimov Moscow State University of Medicine and Dentistry; Central Pediatric Clinical Hospital of the Federal Medico-Biological Agency of Russian Federation

Email: noemail@neicon.ru
Russian Federation

M. A. Kareva

Endocrinology Research Centre

Email: noemail@neicon.ru
ORCID iD: 0000-0003-1320-6561
Russian Federation

References

  1. Gagner M, Lacroix A, Bolte E. Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromacytoma. N Engl J Med. 1992; 327: 1033.
  2. Miller KA, Albanese C, Harrison M, et al. Experience with laparoscopic adrenalectomy in pediatric patients. J Pediatr Surg. 2002; 37(7): 979-82.
  3. Поддубный И.В., Толстов К.Н., Орлова Е.М., Исаев А.А., Городничева Ю.М., Оганесян Р.С. Лапароскопическая адреналэктомия у детей. Хирургия. Журнал им. Н.И. Пирогова. 2011; 9: 53-9.
  4. Казарян А.М., Кузнецов Н.С., Бельцевич Д.Г. Хирургические доступы к опухолям надпочечников. Эндокринная хирургия. 2008; 3: 17-24.
  5. Оганесян Р.С., Толстов К.Н., Поддубный И.В. Лапароскопическая адреналэктомия у детей с доброкачественными новообразованиями надпочечников. Детская хирургия. 2015; 19 (4): 24-9.
  6. Zeiger M.A., Thompson G.B., Duh Quan-Yang et al. American association of endocrinologists and american association of endocrine surgeons medical guidelines for the management of adrenal incidentalomas. Endocrine practice. 2009; 15 (1): 1-20.
  7. Fassnacht M., Arlt W., Bancos I. et al. Management of adrenal incidwntalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. European Journal of Endocrinology. 2016; 175(2): G1-34 https://doi.org/10.1530/EJE-16-0467
  8. Lee Jung-Min, Kim M. K., Ko Seung-Hyun et al. Clinical Guidelines for the Management of Adrenal Incidentaloma. Korean J Med. 2017; 92: 4-16. https://doi.org/10.3803/EnM.2017.32.2.200
  9. Бельцевич Д.Г., Мельниченко Г.А., Кузнецов Н.С. и соавт.. Клинические рекомендации Российской ассоциации эндокринологов по дифференциальной диагностике инциденталом надпочечников. Эндокринная хирургия. 2016; 10(4): 31-42. https://doi.org/10.14341/serg2016431-42
  10. Nuchtern J.G., London W.B., Barnewolt C.E. et al. A prospective study of expectant observation as primary therapy for neuroblastoma in young infants: a Children’s Oncology Group study. Ann Surg. 2012; 256(4): 573-80.
  11. Dokumcu Z. et al., Laparoscopic adrenalectomy in children: A 25-case series and review of the literature. Journal of Pediatric Surgery. 2018; 53(9): 1800-5. https://doi.org/10.1016/j.jpedsurg.2017.11.055
  12. Demirel N., Baş A.Y., Zenciroğlu A., Taşcı-Yıldız Y. Adrenal bleeding in neonates: report of 37 cases. Turk J Pediatr. 2011; 53: 43-7.
  13. Lin X., Wu D., Chen C. et al. Clinical characteristics of adrenal tumors in children: a ret- rospective review of a 15-year single-center experience. Int Urol Nephrol. 2017;49 (3): 381-5. https://doi.org/10.1007/s11255-016-1480-z.
  14. Radiopaedia.org [Internet]. Goel A., Gaillard F. Adrenal haemorrhage. Available from: https://radiopaedia.org/articles/adrenal-haemorrhage.
  15. Феоктистова Е.В., Ускова Н.Г., Варфоломеева С.Р. и соавт. Дифференциальная диагностика кистозной формы нейробластомы и кровоизлияния в надпочечник у детей первых месяцев жизни. Вопросы гематологии/онкологии и иммунопатологии в педиатрии. 2017; 1 (16): 62-8. https://doi.org/10.24287/1726-1708-2017-16-1-62-68
  16. Emedicine.medscape.com [Internet]. Hope W.W. Laparoscopic Right Adrenalectomy. [updated 2017, May 4]. Available from: https://emedicine.medscape.com/article/1894961-overview#showall
  17. Каганцов И.М., Кригерт В.В., Сатаев В.У. и соавт.. Лапароскопическая адреналэктомия при нейробластоме надпочечника у детей. Детская хирургия. 2017; 21(4): 189-93. http//dx.doi.org/10.18821/1560-9510-2017-21-4-189-193
  18. Leclair M-D, de Lagausie P, Becmeur F, et al. Laparoscopic resection of abdominal neuroblastoma. Ann Surg Oncol. 2008;15(1):117-24.
  19. Mirallié, E., Leclair, M.D., de Lagausie, P. et al. Laparoscopic adrenalectomy in children. Surg Endosc. 2001; 15: 156-60.
  20. Theilen, T.M., Paran, T.S., Rutigliano, D. et al. Experience with retroperitoneoscopy in pediatric surgical oncology. Surg Endosc. 2011; 25: 2748-55.
  21. Поддубный И.В., Толстов К.Н., Оганесян Р.С.. Результаты лапароскопической адреналэктомии у детей. Детская хирургия. 2015; 19(1): 11-5

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