Our Summary

This research paper discusses the ongoing importance of open adrenalectomy, a type of surgery performed to remove one or both adrenal glands, despite the advancements in minimally invasive surgical techniques. The paper suggests that open adrenalectomy is still a crucial treatment option for advanced adrenal cancer (ENSAT stage III). This is particularly the case when the cancer has spread to nearby organs, or when blood clots in the kidney vein or major vein (vena cava) or multiple lymph node metastases are present. The paper also suggests open adrenalectomy must be considered for adrenocortical carcinoma at ENSAT stages I-II (tumor size ≤ 5 cm or > 5 cm, N0). Other types of adrenal pathologies, such as neuroblastomas, large pheochromocytomas, schwannomas, and highly suspicious large adrenal tumors (6-8 cm, Hounsfield units > 20) which do not show preoperative evidence of malignancy, could also be treated with open adrenalectomy.

FAQs

  1. What is open adrenalectomy and why is it still important despite advancements in minimally invasive surgical techniques?
  2. In what circumstances is open adrenalectomy considered a crucial treatment option for advanced adrenal cancer?
  3. Which other types of adrenal pathologies can be treated with open adrenalectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about adrenalectomy is to follow post-operative care instructions carefully, including taking prescribed medications, attending follow-up appointments, and avoiding strenuous activities until cleared by the surgeon. It is also important to monitor for any signs of infection or complications and to report any unusual symptoms to the healthcare provider immediately. Additionally, maintaining a healthy lifestyle with regular exercise and a balanced diet can help promote healing and recovery after surgery.

Suitable For

Additionally, patients who have failed minimally invasive adrenalectomy due to technical difficulties or complications may also be recommended for open adrenalectomy. Patients with severe obesity, extensive scarring from previous surgeries, or anatomical variations that make minimally invasive surgery challenging may also benefit from open adrenalectomy. Furthermore, patients with suspected adrenal metastases from other primary cancers or those with large adrenal masses that cannot be adequately visualized or biopsied with minimally invasive techniques may also be candidates for open adrenalectomy. Overall, open adrenalectomy remains an important treatment option for select patients with advanced adrenal pathologies that are not amenable to minimally invasive approaches.

Timeline

Before adrenalectomy:

  1. Initial consultation with a healthcare provider to discuss symptoms and potential treatment options.
  2. Diagnostic tests such as blood tests, imaging studies (CT scans, MRI), and possibly a biopsy to confirm the need for surgery.
  3. Pre-operative preparation including fasting, medication adjustments, and discussions with the surgical team about the procedure and potential risks.

After adrenalectomy:

  1. Recovery in the hospital for a few days to monitor for any complications.
  2. Pain management and instructions for wound care.
  3. Gradual return to normal activities, with restrictions on heavy lifting and strenuous exercise.
  4. Follow-up appointments with the surgical team to monitor healing and address any concerns.
  5. Long-term follow-up to monitor for any signs of recurrence or complications.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with adrenalectomy surgery?
  2. How will the surgery be performed (open vs. minimally invasive) and what are the advantages and disadvantages of each approach?
  3. What is the expected recovery time following the surgery and what can I expect in terms of pain management and post-operative care?
  4. Will I need to take any medications or make any lifestyle changes following the surgery?
  5. What are the long-term implications of having one or both adrenal glands removed?
  6. What is the likelihood of the cancer returning after the surgery and what follow-up care will be necessary?
  7. Are there any alternative treatment options available for my specific condition?
  8. How experienced is the surgical team in performing adrenalectomy procedures?
  9. Will I need any additional tests or imaging studies before the surgery?
  10. What are the success rates for adrenalectomy in treating adrenal cancers at different stages, including my specific stage?

Reference

Authors: Holzer K, Bartsch DK. Journal: Chirurgie (Heidelb). 2022 Sep;93(9):856-860. doi: 10.1007/s00104-022-01678-9. Epub 2022 Jul 4. PMID: 35788865