title: A reappraisal of the indications for laparoscopic treatment of adrenal metastases.
abstract: BACKGROUND
  Laparoscopic adrenalectomy (LA) is unanimously recognized as the gold standard for the surgical treatment of adrenal lesions, but when to remove malignant lesions by this approach still remains controversial.
  
  
  METHODS
  We reviewed all cases of LA for suspected adrenal metastases carried out in our hospital, trying to focus on what should be the ideal preoperative workup, so as to avoid unnecessary operations. The possible role of fine needle aspiration biopsy (FNAB) in selecting patients was evaluated.
  
  
  RESULTS
  Twenty-two patients underwent LA for suspected adrenal metastases from May 1994 to March 2003. Primary tumors were from lung in 14 cases, colon in 2 cases, kidney in 3 cases, thyroid in 2 cases, and breast in 1 case. LA was successfully performed in all but three cases. In 13 patients, 14 FNAB were performed: 8 cases proved to be true positive, 4 true negative, and 2 false negative. Final histology showed 6 cortical adenomas. Local relapse was present only in one patient, who died after 14 months. Of the metastatic patients, 8 are alive and free of disease after a mean followup of 39 months.
  
  
  CONCLUSIONS
  The most accurate workup is of the greatest importance in order to avoid unnecessary surgery for suspected adrenal metastases. The absence of false positives (FP) and the fairly high number of true positives (TP) does not justify the effort of performing FNAB routinely. Indeed, laparoscopic exploration, being simple and quick, allows optimal diagnosis at a low cost, even when histological definition cannot be obtained.
authors.affiliation: Department of General Surgery, University of Pisa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Miccoli
authors.forename: Gabriele
authors.initials: G
authors.lastname: Materazzi
authors.forename: Alfredo
authors.initials: A
authors.lastname: Mussi
authors.forename: Marco
authors.initials: M
authors.lastname: Lucchi
authors.forename: Marco
authors.initials: M
authors.lastname: Massi
authors.forename: Piero
authors.initials: P
authors.lastname: Berti
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged