Rational choice of surgery for adrenal incidentaloma

Objective To discuss the indications of surgery for adrenal incidentaloma.Methods The elinical data of 147 cases of adrenal incidentaloma treated by surgery were reviewed.The indication of surgery was analyzed,and the differences between laparoscopic adrenalectomy and open adrenalectomy were discussed.Results Malignant tumor was identified in 12.9%(19/147).including adrenocortical carcinoma in 15 cases,malignant pheochromocytoma in 4 cases.The mean diameter of these malignant tumor was(8.5±3.9)cm,and 21.1%(4/19)of them were≤4 cm in diameter.Benign functional incidentaloma was found in 19.7%(29/147),the mean diameter was(4.1±2.1)cm,and 75.9%(22/29)of them were≥3 cm in diameter.Two of 19 cases of benign pheochromocytoma had increased 24 hoor urine VMA,2 of 5 cases of aldosterone-producing adenoma showed slightly decreased serum potassium,and 5 cases with subclinical Cushing syndrome had slight elevated plasma cortical steroid level.None of these functionsl incidentaloma had endocrinal symptom.Benign nonfunctionsl tumor was identified in 67.3%(99/147),and 61. 6%(61/99)of them were non-functional adrenal cortical adenoma.A total of 102 cases were performed laparoscopic adrenalectomy and 45 cases for open adrenalectomy.The tumor size of laparoscopy group was(3.4±1.8)cm and(6.7±1.5)cm in open group(P＜0.0001).The overall morbidity rate was 5.9%(6/102)in former and 15.6%(7/45)in latter(P=0.1 103).Laparoscopic adrenalectomies succeeded in 97 cases,while conversion to open procedure in 5 cases(4.9%),most of them were malignant,adhesive,or＞6 cm in diameter.ConclusionsNon-functional adrenal cortical adenoma,pheochromocytoma and adrenocortical carcinoma were the most common adrenal ineidentaloma.Surgery should be considered in all patients with malignancy suspicious,clinical or biochemical evidence of functional tumor,and those of≥3 cm in diameter.Laparoscopy is safe and effective in treatment of incidentloma,but open adrenalectomy could be the first choice when the tumor larger than 6 cm,malignant dubiously or adhere with other organs.Distinguishing non-functional adrenal cortical adenoma from malignancy and functional incidentloma using meticulous pre-operation imaging and biochemical examination could reduce the unnecessary adrenalectomy. Key words: Adrenal gland neoplasms; Surgical procedures,elective