title: [Recurrent operations on the adrenal glands].
abstract: Repeat adrenalectomy may be required due to ipsilateral recurrence of benign or malignant adrenal tumors after previous total or subtotal adrenalectomy. Even for multivisceral resection in patients with adrenocortical carcinoma, complete resection of local recurrent tumor offers results similar to those of primary resection (5-year survival 40-60%). In contrast, since no benefit on long-term survival has been shown so far by tumor debulking, palliative tumor resection should only be performed individually for control of severe endocrine symptoms. The effect of endoscopic adrenalectomy in patients with large tumors (>5 cm) or suspected malignancy has still not been well examined. Further studies are required. In any case, during open or endoscopic approach, tumor spillage must be avoided to prevent local tumor cell implantation. Following subtotal adrenalectomy, the risk of ipsilateral recurrence correlates with disease, follow-up, localization, size of the adrenal remnant, and, in case of familial pheochromocytoma, probably with genotype.
authors.affiliation: Klinik für Allgemein-, Viszeral- und Gefässchirurgie, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale. michael.brauckhoff@medizin.uni-halle.de
authors.forename: M
authors.initials: M
authors.lastname: Brauckhoff
authors.forename: H
authors.initials: H
authors.lastname: Dralle
mesh_terms: D019797:3-Iodobenzylguanidine / Q000627:therapeutic use; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D018268:Adrenocortical Carcinoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D008939:Mitotane / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015282:Octreotide / Q000627:therapeutic use; D010166:Palliative Care; D009384:Paraneoplastic Endocrine Syndromes / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D010673:Pheochromocytoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D012086:Reoperation
chemical_list: D018931:Antineoplastic Agents, Hormonal; D019797:3-Iodobenzylguanidine; D008939:Mitotane; D015282:Octreotide
references.citation: J Endourol. 1999 Mar;13(2):99-104; discussion 104-6
references.pmid: 10213103
references.citation: Arch Surg. 2001 May;136(5):543-9
references.pmid: 11343545
references.citation: Surgery. 2001 Dec;130(6):1072-7
references.pmid: 11742341
references.citation: Ann Thorac Surg. 1996 Jan;61(1):222-4
references.pmid: 8561564
references.citation: World J Surg. 2002 Aug;26(8):1043-7
references.pmid: 12045859
references.citation: Eur J Surg. 1999 May;165(5):431-5
references.pmid: 10391158
references.citation: World J Surg. 1990 May-Jun;14(3):325-9
references.pmid: 1973322
references.citation: World J Surg. 2000 Nov;24(11):1347-52
references.pmid: 11038205
references.citation: World J Surg. 2004 Dec;28(12):1323-9
references.pmid: 15517476
references.citation: World J Surg. 2000 Jan;24(1):108-13
references.pmid: 10594213
references.citation: Surgery. 1992 Dec;112(6):963-70; discussion 970-1
references.pmid: 1455321
references.citation: Eur J Endocrinol. 2004 Jun;150(6):789-92
references.pmid: 15191348
references.citation: Surgery. 2003 Dec;134(6):1020-7; discussion 1027-8
references.pmid: 14668736
references.citation: World J Surg. 2002 Aug;26(8):1005-12
references.pmid: 12045858
references.citation: World J Surg. 1998 Jun;22(6):621-6; discussion 626-7
references.pmid: 9597938
references.citation: N Engl J Med. 1977 Jun 2;296(22):1269-71
references.pmid: 859517
references.citation: Endocr J. 2002 Apr;49(2):227-9
references.pmid: 12081243
references.citation: Surgery. 1995 Dec;118(6):1090-8
references.pmid: 7491528
references.citation: Urology. 1999 Apr;53(4):679-83
references.pmid: 10197840
references.citation: Horm Res. 2002;57(5-6):197-9
references.pmid: 12053093
references.citation: World J Surg. 2001 Jul;25(7):914-26
references.pmid: 11572033
references.citation: Surg Today. 2004;34(3):251-5
references.pmid: 14999539
references.citation: Surgery. 1985 Jan;97(1):16-20
references.pmid: 3966225
references.citation: Surgery. 2000 Dec;128(6):1007-11;discussion 1011-2
references.pmid: 11114636
references.citation: Endocr Rev. 2001 Feb;22(1):75-110
references.pmid: 11159817
references.citation: Ann Surg Oncol. 1999 Dec;6(8):719-26
references.pmid: 10622498
references.citation: Chirurg. 2003 May;74(5):473-7
references.pmid: 12748796
references.citation: World J Surg. 1990 May-Jun;14(3):330-4
references.pmid: 2368435
references.citation: J Clin Endocrinol Metab. 2000 Jan;85(1):5-7
references.pmid: 10634355
references.citation: J Am Coll Surg. 2004 Apr;198(4):525-34; discussion 534-5
references.pmid: 15051000
references.citation: J Pediatr Surg. 1993 Oct;28(10):1248-51; discussion 1251-2
references.pmid: 8263682
references.citation: J Intern Med. 1995 Oct;238(4):363-7
references.pmid: 7595173
references.citation: J Clin Endocrinol Metab. 1989 Nov;69(5):1078-81
references.pmid: 2793991
references.citation: Eur J Surg. 1999 Jun;165(6):535-8
references.pmid: 10433135
references.citation: Surgery. 2003 Dec;134(6):956-62; discussion 962-3
references.pmid: 14668728
references.citation: Surgery. 1996 Dec;120(6):1064-70; discussion 1070-1
references.pmid: 8957496
references.citation: Clin Endocrinol (Oxf). 1997 Jan;46(1):39-44
references.pmid: 9059556
references.citation: World J Surg. 1992 Jul-Aug;16(4):753-8
references.pmid: 1413845
references.citation: Surgery. 2002 Dec;132(6):1008-11; discussion 1012
references.pmid: 12490848
references.citation: J Laparoendosc Adv Surg Tech A. 2004 Aug;14(4):234-5
references.pmid: 15345163
references.citation: J Urol. 1997 Jun;157(6):2239
references.pmid: 9146626
references.citation: J Clin Endocrinol Metab. 2002 Dec;87(12):5367-84
references.pmid: 12466322
references.citation: J Urol. 1999 Feb;161(2):395-8
references.pmid: 9915410
references.citation: J Clin Endocrinol Metab. 2003 Sep;88(9):4083-7
references.pmid: 12970267
references.citation: J Urol. 2000 Jul;164(1):14-7
references.pmid: 10840414
references.citation: Arch Surg. 2002 Jun;137(6):682-8; discussion 688-9
references.pmid: 12049539
references.citation: World J Surg. 1982 Jul;6(4):397-402
references.pmid: 7123976
references.citation: World J Surg. 1984 Aug;8(4):612-21
references.pmid: 6148811
references.citation: Surgery. 1997 Dec;122(6):1068-73; discussion 1073-4
references.pmid: 9426421
references.citation: ANZ J Surg. 2003 Aug;73(8):664-6
references.pmid: 12887546
references.citation: Horm Res. 1999;52(2):97-100
references.pmid: 10681640
references.citation: Eur Urol. 2000 Sep;38(3):344-8
references.pmid: 10940711
references.citation: Minn Med. 1974 Dec;57(12):951-2
references.pmid: 4424014
references.citation: Eur J Endocrinol. 2004 Jul;151(1):15-27
references.pmid: 15248818
references.citation: J Endourol. 2002 Apr;16(3):171-4
references.pmid: 12028627
references.citation: Chirurg. 1989 Apr;60(4):266-71; discussion 271-2
references.pmid: 2566455
references.citation: Arch Surg. 1974 Apr;108(4):450-4
references.pmid: 4815920
references.citation: Front Horm Res. 2004;31:155-62
references.pmid: 14674310
references.citation: Surgery. 1997 Dec;122(6):1212-8
references.pmid: 9426440
references.citation: Br J Surg. 1999 Jan;86(1):94-7
references.pmid: 10027369
references.citation: J Urol. 1998 Aug;160(2):330-4
references.pmid: 9679871
references.citation: Clin Endocrinol (Oxf). 2004 Mar;60(3):273-87
references.pmid: 15008991
references.citation: Surgery. 1983 Dec;94(6):938-40
references.pmid: 6648808
references.citation: Henry Ford Hosp Med J. 1987;35(2-3):127-8
references.pmid: 2891644