Large Adrenal Lesion Series in a Tertiary Care Center in Northern India: Diagnostic and Operative Challenges

AbstractLarge adrenal tumors pose varied challenges to surgeons in terms of diagnosis, planning surgical approach, and also intra-operative difficulties in resection. The aim of this study is to discuss challenges in the management of large and difficult adrenal lesions. A retrospective analysis was done on data of all patients with large adrenal lesions/paragangliomas managed from 1 June 2016 to 30 August 2018. Forty-eight patients with adrenal lesions underwent treatment in 2  years duration. Pain in the abdomen was the most common presentation. Mean age was 34.4 years (range 2–60), female to male (23:25) and right to left side to bilateral tumor 30:16:2. Thirty-one (64.6%) patients had large adrenal masses (size>  6 cm). Surgical approaches included open transperitoneal adrenalectomy (n = 20) and laparoscopic transperitoneal (n = 9 and 2 others had conversion to open procedure). Challenges faced are described in the table below:TumorDifficulties handledTeratomaLarge calcified and retrocaval cystic areas difficult to resect, extensive liver mobilization.Myelolipoma with bleedingAll adjacent planes destroyed by contained hematoma. Decision to embolize and then operate or directly operate was difficult.Large right ACC with renal involvementKidney pushed up and out.Large left ACCSplenomegaly hampered dissection.NeuroblastomaLarge tumor mass indenting and displacing IVC, infiltrating liver and kidney. It was downstaged by chemotherapy and then resected.Malignan...
Source: Indian Journal of Surgical Oncology - Category: Cancer & Oncology Source Type: research