title: Laparoscopic transperitoneal lateral adrenalectomy for malignant and potentially malignant adrenal tumours.
abstract: BACKGROUND
  Laparoscopic adrenalectomy is still controversial in cases where malignancy is suspected. However, many proponents of this technique argue that in the hands of an experienced surgeon, laparoscopy can be safely performed. The aim of this study is to present our own experience with the application of laparoscopic surgery for the treatment of malignant and potentially malignant adrenal tumours.
  
  
  METHODS
  Our analysis included 52 patients who underwent laparoscopic adrenalectomy in 2003-2014 due to a malignant or potentially malignant adrenal tumour. Inclusion criteria were primary adrenal malignancy, adrenal metastasis or pheochromocytoma with a PASS score greater than 6. We analyzed the conversion rate, intra- and postoperative complications, intraoperative blood loss and R0 resection rate. Survival was estimated using the Kaplan-Meier method.
  
  
  RESULTS
  Conversion was necessary in 5 (9.7%) cases. Complications occurred in a total of 6 patients (11.5%). R0 resection was achieved in 41 (78.8%) patients and R1 resection in 9 (17.3%) patients. In 2 (3.9%) cases R2 resection was performed. The mean follow-up time was 32.9 months. Survival depended on the type of tumour and was comparable with survival after open adrenalectomy presented in other studies.
  
  
  CONCLUSIONS
  We consider that laparoscopic surgery for adrenal malignancy can be an equal alternative to open surgery and in the hand of an experienced surgeon it guarantees the possibility of noninferiority. Additionally, starting a procedure with laparoscopy allows for minimally invasive evaluation of peritoneal cavity. The key element in surgery for any malignancy is not the surgical access itself but the proper technique.
authors: 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501, Kraków, Poland. michal.pedziwiatr@uj.edu.pl.
authors: Michał
authors: M
authors: Pędziwiatr
authors: Department of Physiology, Jagiellonian University, Grzegórzecka 16, 31-531, Kraków, Poland.
authors: Mateusz
authors: M
authors: Wierdak
authors: 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501, Kraków, Poland.
authors: Michał
authors: M
authors: Natkaniec
authors: 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501, Kraków, Poland.
authors: Maciej
authors: M
authors: Matłok
authors: Department of Pathology, Jagiellonian University, Grzegórzecka 16, 31-531, Kraków, Poland.
authors: Magdalena
authors: M
authors: Białas
authors: 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501, Kraków, Poland.
authors: Piotr
authors: P
authors: Major
authors: 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501, Kraków, Poland.
authors: Piotr
authors: P
authors: Budzyński
authors: Department of Endocrinology, Jagiellonian University, Kopernika 17, 31-531, Kraków, Poland.
authors: Alicja
authors: A
authors: Hubalewska-Dydejczyk
authors: 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501, Kraków, Poland.
authors: Andrzej
authors: A
authors: Budzyński
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010673:Pheochromocytoma / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D016896:Treatment Outcome