• DOI:10.1007/s13193-020-01114-6
• Corpus ID: 219554751

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

@article{Gaurav2020LargeAL,
  title={Large Adrenal Lesion Series in a Tertiary Care Center in Northern India: Diagnostic and Operative Challenges},
  author={Kushagra Gaurav and Pooja Ramakant and M. Shreyamsa and S. P. Mouli and Kulranjan Singh and Chanchal Rana and Anand Kumar Mishra},
  journal={Indian Journal of Surgical Oncology},
  year={2020},
  volume={11},
  pages={518-526}
}

• Kushagra Gaurav, P. Ramakant, +4 authors A. Mishra
• Published 9 June 2020
• Medicine
• Indian Journal of Surgical Oncology

Large 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: Tumor Difficulties handled Teratoma Large calcified and retrocaval cystic areas difficult to resect, extensive liver mobilization. Myelolipoma with bleeding All adjacent planes destroyed by contained hematoma. Decision to embolize and then operate or directly operate was difficult. Large right ACC with renal involvement Kidney pushed up and out. Large left ACC Splenomegaly hampered dissection. Neuroblastoma Large tumor mass indenting and displacing IVC, infiltrating liver and kidney. It was downstaged by chemotherapy and then resected. Malignant left pheochromocytoma Large extensively infiltrated left adrenal mass led to difficult dissection in posterior and medial planes close to great vessels. ACC with Cushing’s Immunocompromised state, poor lung capacity. ACC For IVC + right atrium thrombus with distant metastases given EDP-M regimen, disease stable for 3 months, then progressed. Ganglioneuroma Para-spinal thoracic mass, on CECT? abdominal mass Right side adrenal lesions Hepatomegaly hampering planes of dissection in laparoscopic surgery There were no major peri-operative morbidities, but two patients died in perioperative period. Large adrenal tumors pose a challenge in surgical planning, approach, and resection and need careful planning and multidisciplinary team approach to have the best outcomes.