[Suprarenal surgical pathology. Experience of 10 years and review of the literature].
OBJECTIVE
Our experience with 34 patients who underwent surgery of the adrenal gland over the last 10 years is presented. The most important clinical and pathological aspects are analyzed, particularly from the perspective of surgery, and the literature on the different pathologies observed in our series is reviewed.


METHODS
A retrospective study was conducted to analyze the clinical features, analytical and hormonal data, imaging technique findings, types of anesthesia, surgical approaches, intra and postoperative morbidity and mortality, course of the disease, and pathological diagnosis.


RESULTS
53% were female. Mean age was 48.8 years. Left-sided involvement was more prevalent (70.7%). The most common pathology was adrenal adenoma (21 pts), followed by metastasis (4), cysts-pseudocysts (4), primary carcinoma (2), pheochromocytoma (1), etc. Hyperaldosteronism (16 pts) was the most common hormonal disorder; 2 patients had Cushing's syndrome, 2 virilizing syndrome, 1 pheochromocytoma, and 13 patients had a nonfunctioning tumor (3 were incidentalomas). The mean size and weight were 5.6 cm and 21.1 gm, respectively. Adenomas were the smallest tumors and those that weighed the least (mean 2.5 cm; 11.5 gm). Primary carcinomas were the largest tumors (mean 18 cm; 52 gm). US and CT were diagnostic in 56% and 100% of the cases and indicated the size of the mass correctly in 75% and 77%, respectively. Special anesthetic was required in 31%; nitroprusside, phenoxybenzamine, labetolol, corticosteroids and spironolactone were administered according to the hormone disorder. Lumbotomy via the 11th or 12th rib was the most common approach (58.7%), followed by the subcostal and transpleuro-diaphragmatic approach (14.7%, 11.7%, respectively), etc. The mean operating time was 162.2 min; adenoma of the adrenal gland required the shortest operating time (133.06 min), while carcinoma of the adrenal gland required the longest (405 min). Some type of intraoperative event arising from the hormonal disorder was observed in 44.2% of the patients. At 45.1 months mean follow-up, 70.5% of the patients were asymptomatic, arterial hypertension persisted in 11.7% and there were 5 deaths (all cases had a malignant tumor).


CONCLUSIONS
The incidence of adrenal gland disease in our series is not unlike that reported in the literature. CT and complementary US are the diagnostic imaging techniques of choice. CT, moreover, has demonstrated a higher specificity. The surgical approach utilized was based on the pathological condition for which surgery had been indicated. The posterolateral and transpleurodiaphragmatic approaches were utilized for small tumors and no remarkable events were observed during the procedure. The anterior and combined approaches were utilized for large or bilateral tumors or obese patients. Our morbidity rate is not unlike that reported in the literature and basically depends on the chronic disease of the patient, type of hormonal disorder and size or malignant nature of the tumor.
Salinas Sánchez
A
A
Servicio de Urología, Hospital General de Albacete, España.
Lorenzo Romero
J
J
Segura Martín
M
M
Hernández Millán
I
I
Pastor Guzmán
J
J
Virseda Rodríguez
J
J
D000293:Adolescent; D000307:Adrenal Gland Diseases / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D000368:Aged; D000758:Anesthesia; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative
Patología quirúrgica suprarrenal. Experiencia de diez años y revisión de la literatura.