[Indications for conventional adrenalectomy].
BACKGROUND
Conventional adrenalectomy still plays an important role, even in the era of minimally invasive endocrine surgery. It was the aim of our study to analyse the indications for conventional adrenalectomy in our own patients since the introduction of the minimally invasive technique in the year 1994 - laparoscopically and retroperitoneoscopically.


METHODS
Between January 1994 and September 2006, a total of 412 adrenalectomies were performed in 380 patients. Out of these, 106 operations (25.7 %) were carried out conventionally in 98 patients, and 306 operations (74.3 %) endoscopically in 282 patients.


RESULTS
Indications for conventional adrenalectomy were - as compared with the minimally invasive procedure - significantly more frequent adrenocortical carcinomas (ACC), especially in the context of multivisceral resections, as well as adrenal metastases (synchronous and metachronous). In contrast, adrenal Cushing's disease (including 19 patients with bilateral tumours), pheochromocytoma, incidentaloma and Conn's syndrome constituted a more frequent indication for minimally invasive adrenalectomy. Conventionally operated adrenal pathologies with on average 6.0 (range: 1.2-19.0) cm diameter were significantly larger than the endoscopically removed tumours with on average 3.3 (range: 0.2-9.2) cm diameter (p < 0.0001). The side localisation and the frequency of bilateral adrenal tumours did not differ significantly in the two groups.


CONCLUSIONS
Since the establishment of the minimally invasive technique in 1994, conventional adrenalectomy has been selected for 26 % of all resected adrenal pathologies at our clinic and, therefore, still plays an important role even in the era of laparoscopic surgery. The benefit of the laparoscopic procedure in the case of malignant pheochromocytoma, adrenocortical carcinoma, and isolated adrenal metastases at a locally confined stage is still unclear and requires prospective, randomised studies.
Gockel
I
I
Klinik und Poliklinik für Allgemein- und Abdominalchirurgie, Johannes Gutenberg-Universität Mainz. gockel@ach.klinik.uni-mainz.de
Heintz
A
A
Domeyer
M
M
Trinh
T T
TT
Dünschede
F
F
Junginger
T
T
D000306:Adrenal Cortex Neoplasms / Q000473:pathology / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D000311:Adrenal Glands / Q000473:pathology; D000315:Adrenalectomy / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003480:Cushing Syndrome / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000473:pathology / Q000601:surgery; D008297:Male; D008432:Mathematical Computing; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data*; D010673:Pheochromocytoma / Q000473:pathology / Q000601:surgery; D014600:Utilization Review / Q000706:statistics & numerical data