title: Retroperitoneal adrenal-sparing surgery for the treatment of Cushing's syndrome caused by adrenocortical adenoma: 8-year experience with 87 patients.
abstract: BACKGROUND
  The objective of this study was to present our 8-year experience with partial adrenalectomy via the retroperitoneal approach for the treatment of Cushing's adenoma.
  
  
  METHODS
  A total of 93 patients who underwent adrenal surgery for Cushing's adenoma from March 2003 to December 2010 were enrolled in this study. Preoperative, intraoperative, and postoperative variables were reviewed from the database. Student's t test was used to analyze the continuous data, and the χ(2) test was used to analyze the categoric data. A value of p < 0.05 was considered statistically significant.
  
  
  RESULTS
  Adrenal-sparing surgery was performed in 87 cases (31 by open surgery, 56 by retroperitoneal laparoscopy). Six patients underwent open/laparoscopic total adrenalectomy because of recurrent disease or a large size. The cure rate in our series was 97.8%. Hypertension resolved in 34 of 64 patients (53.1%), diabetes in 7 of 27 patients (25.9%) and obesity in 28 of 48 patients (58.3%). One patient died during the postoperative period. The intraoperative complication rate for the open surgery group was significantly higher than that for the retroperitoneal laparoscopy group (9.1 vs. 1.7%).
  
  
  CONCLUSIONS
  The retroperitoneal approach is reliable and safe for treating Cushing's syndrome. The laparoscopic technique can decrease the prevalence of intraoperative complications. Retroperitoneal laparoscopic partial adrenalectomy can be performed with extremely low morbidity and achieves an excellent outcome, although death may occur during the postoperative period in high-risk patients. Postoperative management plays an important role in the surgical treatment of Cushing's syndrome.
authors.affiliation: Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China.
authors.forename: Hong-Chao
authors.initials: HC
authors.lastname: He
authors.affiliation: Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Dai
authors.affiliation: Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China. shenzj6@hotmail.com.
authors.forename: Zhou-Jun
authors.initials: ZJ
authors.lastname: Shen
authors.affiliation: Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China.
authors.forename: Fu-Kang
authors.initials: FK
authors.lastname: Sun
authors.affiliation: Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Shao
authors.affiliation: Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China.
authors.forename: Rong-Ming
authors.initials: RM
authors.lastname: Zhang
authors.affiliation: Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China.
authors.forename: Hao-Fei
authors.initials: HF
authors.lastname: Wang
authors.affiliation: Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China.
authors.forename: Wen-Bin
authors.initials: WB
authors.lastname: Rui
authors.affiliation: Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China.
authors.forename: Shan
authors.initials: S
authors.lastname: Zhong
mesh_terms: D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D018246:Adrenocortical Adenoma / Q000150:complications / Q000401:mortality / Q000601:surgery*; D000328:Adult; D003480:Cushing Syndrome / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult