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Type: Artigo de periódico
Title: Open Surgical Treatment Of Right-sided Adrenal Carcinomas >15 Cm.
Author: Ferreira, Ubirajara
Nardi Pedro, Renato
Matheus, Wagner Eduardo
Prudente, Alessandro
Mendonça Borges, Gustavo
Rodrigues Netto, Nelson
Abstract: Adrenal carcinomas are rare and are associated with a very poor prognosis. The incidence is estimated to be 1 in 1.7 million which represents 0.02% of all cancers and 0.2% of all cancer mortality. The 5-year survival rate is 38%. The purpose of this paper is to present a single-institution experience in excising right-sided giant adrenal carcinomas, discussing the difficulties and the usage of special surgical devices to facilitate the procedure. During June 2001 to June 2003, 18 patients with right-sided adrenal tumors were treated at the State University of Campinas Hospital--UNICAMP. 4 out of the 18 patients presented lesions >15 cm, representing the study group. The mean age was 37 (range 26-65) years, 3 patients were younger than 35 years, and 2 patients were men. A right-sided extended subcostal incision was the surgical access in 1 patient (case 1) and a right-sided thoracoabdominal incision in the other 3 patients. Adrenal cortical carcinoma was the histological diagnosis according to the Weiss criteria; no positive surgical margin was detected, even in those patients with invasion of the hepatic capsule. The median follow-up period was 15 (range 6-30) months. A subcostal extended incision can accomplish broad exposure, if articulated costal retractors are available (used in liver transplantation), otherwise a thoracoabdominal incision is the best option. The most important feature of surgery is to accomplish an efficient hemostasis of the liver parenchyma. Suture and stitches are not suitable for minor vascular structures, and electrocauterization sometimes promotes hepatic lesions and does not provide bleeding control. Thus, the need for special hemostatic means is real, and they should be available in these situations.
Subject: Adrenalectomy
Adrenocortical Carcinoma
Diagnosis, Differential
Follow-up Studies
Magnetic Resonance Imaging
Middle Aged
Retrospective Studies
Treatment Outcome
Citation: Urologia Internationalis. v. 78, n. 1, p. 46-9, 2007.
Rights: fechado
Identifier DOI: 10.1159/000096934
Date Issue: 2007
Appears in Collections:Unicamp - Artigos e Outros Documentos

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