SURGICAL METHODS FOR TREATING ADRENAL TUMORS

Treatment of adrenal tumors

Malignant and benign tumors of the adrenal glands are rare -
from 0.5 to 2 cases per million people. Despite this, we apply advanced medical developments in practice to treat them, achieving excellent results even in complex patients.

We understand how important it is to start treatment in a short time: oncology patients are seen by appointment without waiting in line. You can see an oncologist the very next day after the call, and begin therapy within 5-7 days if the necessary tests are available. A team of oncologists, radiologists, chemotherapists, and rehabilitation specialists works with each patient.

Modern surgical techniques used in our clinic make it possible to completely remove the tumor and increase the chances of recovery.

Surgery to remove adrenal adenoma

Surgery to remove an adrenal adenoma can be performed in three ways: open surgery, laparoscopic or robot-assisted.

Laparoscopic adrenalectomy is performed when small benign tumors of the adrenal glands are detected. It is characterized by less trauma during tumor removal, faster recovery after surgery, and an acceptable cosmetic result, which together makes it possible to achieve maximum effectiveness in correcting hormonal imbalances. However, if a malignant tumor of the adrenal gland is suspected, surgeons all over the world tend to perform open surgery , as this reduces the risk of tearing the tumor capsule, which is the most important component of the radicality of the operation.

Robot-assisted adrenalectomy is an operation characterized by minimally invasive intervention and has the following advantages:

maximum accuracy of manipulations;
minimal blood loss;
excellent visualization of the tumor thanks to 3D images with multiple magnification of the surgical area and the possibility of using ultrasound navigation;
high mobility of robot tools, incomparable to a human hand;
minimal recovery period.

Symptoms of adrenal tumors

Symptoms depend on the type of tumor. Benign tumors and formations without hormonal activity usually do not manifest themselves.

Signs of adrenal tumors with hormonal activity are associated with an excess of one of the hormones:

aldosterone -
the exchange of water and salts is disrupted, blood pressure rises, and muscle weakness appears;
glucocorticoids - Itsenko-Cushing syndrome develops: excess weight, hypertension, decreased libido;
androgens - male sex hormones, in men it manifests itself as baldness and muscle growth. In women, symptoms of adrenal tumors of this type: hair growth on the body and face, deepening of the voice;
estrogens - female sex hormones, more common in men, causing feminization and weakness;
catecholamines - vegetative crises develop

In these cases, you should consult a doctor as soon as possible to clarify the diagnosis. At the 21st Century Oncology Clinic, you can undergo the necessary examinations in a short time: from the first visit to the doctor to the diagnosis usually takes no more than 7 days.

Types and stages of adrenal tumors

There are benign and malignant tumors of the adrenal glands; in addition, they are hormonally active and hormonally inactive.

Neoplasms are distinguished by location:

cortical layer - corticosteromes, corticoestromes, aldosteromes, androsteromes and others.
medulla - pheochromocytomas and ganglioneuromas.

We treat all types of adrenal tumors, using innovative surgical techniques to reduce the risk of recurrence.

Adrenal adenoma in women and men: treatment

The doctor builds a treatment regimen based on the diagnostic results.

Tumor size less than 4 cm A small, hormonally inactive benign tumor does not require special treatment. Initially low-density according to CT data and hormonally inactive small-sized adrenal tumors (up to 4 cm), according to international recommendations, do not even require dynamic monitoring. In case of suspicious CT data and a small tumor size (up to 3 cm), an initial observation interval of 3 months is considered optimal.

Tumor size is more than 4 cm If the tumor is enlarged in size (more than 4 cm), there are any doubts about its malignancy, or the tumor is hormonally active, an operation is performed to remove the adenoma of the left or right adrenal gland - adrenalectomy.

How can we help with adrenal tumors?

We offer compulsory medical insurance treatment in accordance with international standards. In each case, we hold a consultation with the participation of oncologists, surgeons, radiologists and chemotherapists to select effective treatment.
We adhere to fasttrack surgery standards -
competent preparation for surgery to remove adrenal tumors, gentle intervention techniques, active recovery, individual selection of anesthesia. This shortens the recovery time and reduces the risk of complications.

Currently, extraperitoneal lumbar access is the most modern and low-traumatic method for removing adrenal tumors. The name of this method is difficult to pronounce and is not clear at first glance, but if you explain this name of the method, everything will become clear. “Retro” means that the incision is not on the stomach, but on the back, in the lumbar region, without entering the abdominal cavity. "Peritoneo" is the Latin name for the abdominal cavity. “Scopy” refers to the use of a special camera and delicate surgical instruments. This method of removing the adrenal gland involves placing skin incisions on the back, without entering the abdominal cavity, using special endoscopic equipment (video camera, thin clamps, scissors and coagulators). In this case, the patient lies on his stomach on the operating table.

This method of removing the adrenal gland was first described by the German surgeon MK Walz from Essen (Germany). In 2001, Professor Walz showed 5 years of experience using a lumbar extraperitoneal approach to remove the affected adrenal gland. Since that time, several thousand similar operations have been performed around the world, which have shown their effectiveness and safety in comparison with traditional approaches and laparoscopic methods.

Technique for performing adrenal gland removal using an extraperitoneal lumbar approach

Currently, there are two options for removing adrenal tumors using the lumbar approach:

When performing a traditional extraperitoneal approach, the patient is positioned on his stomach, with his legs adducted and bent at the knees and hip joints. The surgeon performs three punctures in the lumbar region, on the right or left, depending on the location of the tumor. Next, using a video camera and two instruments, he enters the retroperitoneal space. In this case, the instruments do not come into contact with the abdominal organs, thereby minimizing the risk of damage. A special gas enters the retroperitoneal space, thereby creating an area for the surgeon to work. Under constant video control, the surgeon identifies the adrenal tumor step by step, and after crossing its main vessels, removes it through one of the punctures. If the adrenal glands are small and there is no pronounced fatty tissue in the retroperitoneal space, the operation time can be less than 60 minutes. The size of the tumor can be up to 10 cm in diameter.

The single-port technique for performing extraperitoneal lumbar access is the most modern method for removing adrenal tumors. Its main difference from traditional surgery is the presence of only one puncture (!), usually 3 cm long, through which the surgeon passes a video camera and the necessary instruments. After the adrenal tumor is isolated, it is removed. One stitch is placed on the skin, and after a few days the scar on the back is barely noticeable.

Advantages and disadvantages of extraperitoneal lumbar approach

Flaws

If the tumor spreads beyond the adrenal gland to neighboring organs - kidney, stomach, inferior vena cava, intestines - using this access may be problematic. In such a situation, they resort to traditional laparotomy. Fortunately, in the vast majority of cases, adrenal tumors have capsules and do not grow into surrounding tissues and organs, which allows the use of a lumbar approach.

Advantages

The use of extraperitoneal lumbar access has the following advantages over others:

"Fast path" to the adrenal gland. To reach the adrenal tumor, it is enough to dissect the skin, fascia and back muscles. Anatomically, the adrenal gland is located closer to the back.
The level of postoperative pain is minimal.
The patient lies on his stomach and there is no load on the spine, as in traditional operations.
The patient can eat and drink water in the evening after surgery.
The cosmetic result is excellent; when using a single-port technique, the patient is left with one barely noticeable suture in the lumbar region.
There is no risk of adhesions in the abdominal cavity.
Discharge from the clinic for 2-3 days.

It is recommended to periodically undergo diagnostics for the timely detection of possible adrenal gland diseases. In our endocrinology center you can quickly and inexpensively undergo all necessary diagnostic procedures. For more detailed advice, please contact an endocrinologist and surgeon in Krasnodar. You can make an appointment by calling: +7 (918) 493-75-92.

Diagnosis of adrenal tumors

We use modern diagnostic methods that allow us to quickly determine the type of tumor and prescribe appropriate therapy:

Determining the concentration of hormones in the blood and urine helps
to identify hormonal tumors and determine their activity.
Ultrasound, CT, MRI to clarify the size and location of nodes.
PET/CT is
a detailed study of malignant tumors on a modern scanner and detection of metastases from 2 mm.

Biopsy with histology -
taking a tissue sample to determine the type of cancer cells and their malignancy.

An oncologist may prescribe other tests or examinations for you: each case is unique, and an individual diagnostic regimen is needed to make an accurate diagnosis.

Treatment of adrenal tumors

We select treatment for adrenal tumors taking into account the severity of the disease and the patient’s condition. We not only treat the disease, but also maintain the quality of life of our patients after therapy:

Observation by an oncologist is
necessary for small benign tumors.
Surgical treatment is
indicated for hormonally active and malignant tumors, benign formations larger than 3 cm. The entire affected adrenal gland is removed. At the 21st Century Oncology Clinic, we use minimally invasive techniques to preserve the kidney and its functions.
Chemotherapy -
prescribed for tumors sensitive to chemotherapy.

Adrenal resection

Adrenal tumors, unfortunately, are very common nowadays.
And the only method to get rid of this disease is surgery. There are many techniques for resection of the adrenal gland. Previously, to remove an adrenal tumor, incisions of approximately 10-15 cm in size were made on the back, abdomen and side. Esophageal hernia There are many types of hernia, and one of them is a hiatal hernia, abbreviated as hiatal hernia. A hiatal hernia is associated with a disease of the esophagus and the ligamentous apparatus of the diaphragm. The food opening expands in the diaphragm, this helps to expand the ligaments that fix the esophagus and stomach, and through this expansion the upper part of the stomach enters the chest cavity.

Colon Barzilai Hospital is ready to perform surgery on the colon of any complexity, regardless of the disease.

Appendicitis Removal Laparoscopic appendicitis surgery is one of the most common surgeries and many people have gone through it. In other words, appendectomy means removal of the appendix, the appendix, and by such an ailment as “appendicitis”, we most often understand such a phenomenon as inflammation of the appendix.

Removal of the spleen Splenectomy is an operation to remove the spleen. The spleen is an important part of supporting the human immune system. It contains a large number of leukocytes that protect the body from bacteria and various types of infections, and it also destroys used red blood cells. The spleen does not regenerate and cannot recover after partial removal.

Today, minimally invasive surgery technologies have been developed so much that they make it possible to make incisions on the abdomen measuring 0.5-1 cm, while the number of sizes has been reduced to 3-4. This method is called laparoscopic adrenalectomy. During the operation, endoscopic equipment and special surgical instruments are used.

There are the following indications for resection of the adrenal gland using this method:

benign non-functional tumors,

benign functional tumors,

· adrenal cancer.

Another method involves a 3 cm incision in the umbilical area, and this method is called the “single laparoscopic approach”. This allows you to reduce the time of hospital stay to 2 days, and the recovery period ends much earlier than in the case of open surgery of the adrenal gland.

The preparatory process before resection of the adrenal gland and possible approaches to it depend on the following factors:

The nature of the lesion in the surgical area,

Degree of dysfunction of the adrenal gland

In addition, there are a number of advantages of laparoscopic surgery over abdominal surgery:

· the equipment of the Barzilai hospital allows surgical intervention to be carried out more delicately, with less trauma to tissues and blood loss,

This method of resection of the adrenal gland allows us to identify the existence of any pathologies

Laparascopic surgery provides good cosmetic effects,

· the hospitalization period and recovery period are much shorter than with cavitary.

When preparing a patient for surgery, doctors may prescribe steroids if there is a risk of adrenal insufficiency. Exceptions are cases when a person is sick

pheochromacytoma,
neuroblastoma.

The hospital stay and the recovery process during the period of replacement therapy largely depend on the amount of adrenal tissue that is preserved after surgery.