Preoperative workup in the assessment of adrenal incidentalomas: outcome from 282 consecutive laparoscopic adrenalectomies.

Abstract

BACKGROUND:

To confirm the efficacy of preoperative workup, the authors analyse the results of a multicentre study in a surgical series of patients diagnosed with an adrenal incidentaloma.

METHODS:

The retrospective review of a prospectively collected database was conducted. The data was obtained by six surgical units operating in the Campania Region, Italy. Five-hundred and six (506) adrenalectomies performed between 1993 and 2011 on 498 patients were analysed. Final histology in patients with a preoperative diagnosis of incidentaloma and studied according to guidelines (230/282 patients group A) was compared with final histology coming from patients presenting the same preoperative diagnosis but studied not according to guidelines (52/282 patients group B).

RESULTS:

In group A preoperative diagnosis was confirmed at final histology in 76/81 (93.8%) cases of subclinical functioning lesions presenting as an incidentaloma. The preoperative detection of pheochromocytoma and primary adrenocortical cancer (ACC) reached 91.6% and 84.6% respectively. In group B conversion rate to open surgery was higher than in group A (p = 0.02). One pheochromocytoma was missed at preoperative diagnosis whereas one ACC smaller than 4 centimetres (cm) and coming from an incidental lesion was discovered. In both groups a significant association between increasing dimensions of incidentaloma and cancer has been observed (p = 0.001).

CONCLUSIONS:

This surgical series confirm the high efficacy of suggested guidelines. A significant preoperative detection rate of adrenal lesions presenting as incidentaloma is observed. The unnecessary number of adrenalectomies performed in understudied patients, causing higher morbidity, was not associated to a higher detection rate of primary adrenocortical cancer.

• Authors: Mario Musella, Giovanni Conzo, Marco Milone, Francesco Corcione, Giulio Belli, Maurizio De Palma, Annunziato Tricarico, Luigi Santini, Antonietta Palazzo, Paolo Bianco, Bernadette Biondi, Rosario Pivonello, Annamaria Colao
• Journal: BMC surgery (BMC Surg) Vol. 13 Pg. 57 (Nov 27 2013) ISSN: 1471-2482 [Electronic] England
• PMID: 24279337 (Publication Type: Evaluation Study, Journal Article, Multicenter Study)

Topics

• Adolescent
• Adrenal Cortex Neoplasms (diagnosis, surgery)
• Adrenal Gland Neoplasms (diagnosis, surgery)
• Adrenalectomy (methods, statistics & numerical data)
• Adrenocortical Carcinoma (diagnosis, surgery)
• Adult
• Aged
• Female
• Humans
• Incidental Findings
• Italy
• Laparoscopy (statistics & numerical data)
• Male
• Middle Aged
• Pheochromocytoma (diagnosis, surgery)
• Practice Guidelines as Topic
• Preoperative Care (methods, standards)
• Retrospective Studies
• Unnecessary Procedures (statistics & numerical data)
• Young Adult