Results of laparoscopic adrenalectomy for suspected and unsuspected XXXX .

@entity1 @entity706 @entity5 @entity16663 @entity3 @entity4304
BACKGROUND: Laparoscopic resection for malignant @entity5 is controversial, because they are rare and limited data exist in the literature. HYPOTHESIS: Laparoscopic adrenalectomy for malignant @entity5 is safe and effective. @entity1 AND METHODS: Twenty-three @entity1 who had a laparoscopic approach for suspected and unsuspected malignant @entity5 were studied retrospectively. The adrenal mass was suspected to be metastatic if the @entity1 had a history of previous extra-adrenal primary malignancy and/or positive fine-needle aspiration cytologic findings. A primary @entity4304 was suspected if there were positive fine-needle aspiration cytologic findings and/or a malignant adrenal imaging phenotype. MAIN OUTCOME MEASURES: (1) Margins of @entity5 resection, (2) @entity5 recurrence (locoregional, port site, and distant), and (3) disease-free survival. RESULTS: Twenty-three @entity1 (15 @entity1 and 8 @entity1 ) had 24 laparoscopic procedures (20 adrenalectomies, 3 biopsies, and 1 diagnostic laparoscopy). Permanent histologic specimens in the 23 @entity1 showed 5 @entity16663 , 1 undifferentiated @entity4304 , 13 adrenal metastases, 2 @entity706 , and 2 cases with no evidence of @entity5 . Clinically suspected adrenal metastases were true positive in 19 @entity1 (83%). The sensitivity of fine-needle aspiration cytology was 57% (n = 7). Only 1 of 6 @entity1 with primary @entity4304 was suspected to have a @entity5 preoperatively. The @entity5 resection margin was negative in all adrenalectomies. There were 3 locoregional recurrences (2 local and 1 lymph node @entity3 ) in the 6 @entity1 with primary @entity4304 , no port site recurrences, and 4 distant recurrences in 13 @entity1 with metastatic @entity5 . The disease-free survival was 65% at a mean follow-up time of 3.3 years (range, 1-7 years). CONCLUSIONS: A laparoscopic approach in @entity1 with suspected adrenal @entity3 can be both diagnostic and therapeutic, and achieves complete @entity5 resection. In contrast, laparoscopic adrenalectomy for clinically unsuspected @entity16663 is associated with a high recurrence rate. Furthermore, preoperative fine-needle aspiration cytology for the evaluation of suspected malignant @entity5 is unreliable.
