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Minimally invasive resection of adrenal masses in infants and children: results of a European multi-center survey

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An Erratum to this article was published on 22 June 2017

This article has been updated

Abstract

Background

Minimal access adrenal surgery (MAAS) for adrenal pathologies is the standard for many pediatric surgical centers. However, the literature offers few reports and minimal evidence from small case series. The aim of this study was to evaluate the outcomes of pediatric MAAS through a multi-center data analysis.

Method

Pediatric patients who underwent MAAS between January 2002 and December 2013 were retrospectively included. Data analysis was conducted using Spss software (Welch's t-test, X-square, Fisher tests, multiple regression model).

Results

Six European centers participated, 68 patients were included with mean age of 5.2 years (2 months–16 years). Lesion volume was of 18.1 cc (0.78–145.6), with a mean diameter of 2.8 cm (1.1–6.5). Localization was 50% left-sided masses, 45.6% right-side masses, and 4.4% bilateral. Histological examination revealed 36 neuroblastomas, 15 adenomas, nine pheochromocytomas, three ganglioneuromas, two ganglioneuroblastomas, one bilateral hyperplasia, one adrenocortical carcinoma, an alveolar sarcoma, and a calcification. Surgical access was transperitoneal in 63 (92.6%) and retroperitoneal in 5 (7.4%). Mean operative time was 170 ± 87 min (285 ± 30 min for bilateral lesions). Mean hospital stay was 4.2 ± 2.5 days. Complications included blood loss requiring transfusion in five patients (7.4%) and a diaphragmatic tear. Infiltration of surrounding structures correlated with intraoperative complication rate (p = 0.027) and operative time (p < 0.01). No mass rupture, conversion, or post-operative complications were observed. Median follow-up was 52 months (1–161). Two recurrences occurred in patients with pheochromocytoma. Age, weight, symptoms, characteristics at imaging, chemistry, volume, or histology, did not influence operative time, hospital stays, or complication rate.

Conclusions

Pediatric MAAS was safe adopted for masses up to 145.6 cc, with a very low rate of complication. Conversion to open is not necessary even in the presence of infiltrations. MAAS should represent the first-line treatment for selected cases in centers experienced in laparoscopy.

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Change history

  • 22 June 2017

    An erratum to this article has been published.

References

  1. Balassy C, Navarro OM, Daneman A (2011) Adrenal masses in children. Radiol Clin North Am 49:711–727

    Article  PubMed  Google Scholar 

  2. Fisher JP, Tweddle DA (2012) Neonatal neuroblastoma. Semin Fetal Neonatal Med 17:207–215

    Article  PubMed  Google Scholar 

  3. Cohn SL, Pearson AD, London WB, Monclair T, Ambros PF, Brodeur GM, Faldum A, Hero B, Iehara T, Machin D, Mosseri V, Simon T, Garaventa A, Castel V, Matthay KK, INRG Task Force (2009) The International Neuroblastoma Risk Group (INRG) classification system: an INRG Task Force report. J Clin Oncol 27:289–297

    Article  PubMed  PubMed Central  Google Scholar 

  4. Barontini M, Levin G, Sanso G (2006) Characteristics of pheochromocytoma in a 4–20-year-old population. Ann N Y Acad Sci 1073:30–37

    Article  PubMed  Google Scholar 

  5. Heloury Y, Muthucumaru M, Panabokke G, Cheng W, Kimber C, Leclair MD (2012) Minimally invasive adrenalectomy in children. J Pediatr Surg 47:415–421

    Article  PubMed  Google Scholar 

  6. Havekes B, Romijn JA, Eisenhofer G, Adams K, Pacak K (2009) Update on pediatric pheochromocytoma. Pediatr Nephrol 24:943–950

    Article  PubMed  Google Scholar 

  7. Ciftci AO, Senocak ME, Tanyel FC, Buyukpamukcu N (2001) Adrenocortical tumors in children. J Pediatr Surg 36:549–554

    Article  CAS  PubMed  Google Scholar 

  8. Van Wyk JJ, Ritzen EM, Monclair T, Brodeur GM, Ambros PF, Brisse HJ, Cecchetto G, Holmes K, Kaneko M, London WB, Matthay KK, Nuchtern JG, von Schweinitz D, Simon T, Cohn SL, Pearson AD, INRG Task Force (2009) The role of bilateral adrenalectomy in the treatment of congenital adrenal hyperplasia; the International Neuroblastoma Risk Group (INRG) staging system: an INRG Task Force report. J Clin Oncol 88:2993–2998

    Google Scholar 

  9. Masiakos PT, Gerstle JT, Cheang T, Viero S, Kim PC, Wales P (2004) Is surgery necessary for incidentally discovered adrenal masses in children? J Pediatr Surg 39:754–758

    Article  PubMed  Google Scholar 

  10. Gagner M, Lacroix A, Bolte E (1992) Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 327:1033

    Article  CAS  PubMed  Google Scholar 

  11. Yamamoto H, Yoshida M, Sera Y (1996) Laparoscopic surgery for neuroblastoma identified by mass screening. J Pediatr Surg 31:385–388

    Article  CAS  PubMed  Google Scholar 

  12. Monclair T, Brodeur GM, Ambros PF, Brisse HJ, Cecchetto G, Holmes K, Kaneko M, London WB, Matthay KK, Nuchtern JG, von Schweinitz D, Simon T, Cohn SL, Pearson AD, INRG Task Force (2009) The international neuroblastoma risk group (INRG) staging system: an INRG task force report. J Clin Oncol 27:298–303

    Article  PubMed  PubMed Central  Google Scholar 

  13. Mattioli G, Avanzini S, Pini Prato A, Pio L, Granata C, Garaventa A, Conte M, Manzitti C, Montobbio G, Buffa P (2014) Laparoscopic resection of adrenal neuroblastoma without image-defined risk factors: a prospective study on 21 consecutive pediatric patients. Pediatr Surg Int 30:387–394

    Article  PubMed  Google Scholar 

  14. Cribbs RK, Wulkan ML, Heiss KF, Gow KW (2007) Minimally invasive surgery and childhood cancer. Surg Oncol 16:221–228

    Article  PubMed  Google Scholar 

  15. Metzelder ML, Kuebler JF, Shimotakahara A, Glueer S, Grigull L, Ure BM (2007) Role of diagnostic and ablative minimally invasive surgery for pediatric malignancies. Cancer 109:2343–2348

    Article  PubMed  Google Scholar 

  16. Leclair MD, de Lagausie P, Becmeur F, Varlet F, Thomas C, Valla JS, Petit T, Philippe-Chomette P, Mure PY, Sarnacki S, Michon J, Heloury Y (2008) Laparoscopic resection of abdominal neuroblastoma. Ann Surg Oncol 15:117–124

    Article  PubMed  Google Scholar 

  17. Cecchetto G, Riccipetitoni G, Inserra A, Esposito C, Michelazzi A, Ruggeri G, Spinelli C, Lima M, Italian Group of Pediatric Surgical Oncology (2010) Minimally-invasive surgery in paediatric oncology: proposal of recommendations. Pediatr Med Chir 32:197–201

    CAS  PubMed  Google Scholar 

  18. St Peter SD, Valusek PA, Hill S, Wulkan ML, Shah SS, Martinez Ferro M, Bignon H, Laje P, Mattei PA, Graziano KD, Muensterer OJ, Pontarelli EM, Nguyen NX, Kane TD, Qureshi FG, Calkins CM, Leys CM, Baerg JE, Holcomb GW (2011) Laparoscopic adrenalectomy in children: a multicenter experience. J Laparoendosc Adv Surg Tech A 21:647–649

    Article  PubMed  Google Scholar 

  19. Orzech N, Zamakhshary M, Langer JC (2008) Level of evidence in minimal access pediatric surgery. J Laparoendosc Adv Surg Tech A 18:140–146

    Article  PubMed  Google Scholar 

  20. Dingemann J, Ure BM (2013) Systematic review of level 1 evidence for laparoscopic pediatric surgery: do our procedures comply with the requirements of evidence-based medicine? Eur J Pediatr Surg 23:474–479

    Article  PubMed  Google Scholar 

  21. Fiszer P, Toutounchi S, Pogorzelski R, Krajewska E, Ciesla W, Skorski M (2012) Laparoscopic adrenalectomy−assessing the learning curve. Pol J Surg 84:293–297

    Google Scholar 

  22. Guerrieri M, Campagnacci R, De Sanctis A, Baldarelli M, Coletta M, Perretta S, Al-Shanafey S, Habib Z (2008) The learning curve in laparoscopic adrenalectomy; Feasibility and safety of laparoscopic adrenalectomy in children: special emphasis on neoplastic lesions. J Laparoendosc Adv Surg Tech A 11:415–419

    Google Scholar 

  23. Goitein D, Mintz Y, Gross D, Reissman P (2004) Laparoscopic adrenalectomy: ascending the learning curve. Surg Endosc 18:771–773

    Article  CAS  PubMed  Google Scholar 

  24. Al-Shanafey S, Habib Z (2008) Feasibility and safety of laparoscopic adrenalectomy in children: special emphasis on neoplastic lesions. J Laparoendosc Adv Surg Tech A 18:306–309

    Article  PubMed  Google Scholar 

  25. Romano P, Avolio L, Martucciello G, Steyaert H, Valla JS (2007) Adrenal masses in children: the role of minimally invasive surgery. Surg Laparosc Endosc Percutan Tech 17:504–507

    Article  PubMed  Google Scholar 

  26. Lopes RI, Denes FT, Bissoli J, Mendonca BB, Srougi M (2012) Laparoscopic adrenalectomy in children. J Pediatr Urol 8:379–385

    Article  PubMed  Google Scholar 

  27. Gunther P, Holland-Cunz S, Schupp CJ, Stockklausner C, Hinz U, Schenk JP (2011) Significance of image-defined risk factors for surgical complications in patients with abdominal neuroblastoma. Eur J Pediatr Surg 21:314–317

    Article  CAS  PubMed  Google Scholar 

  28. Rodriguez-Galindo C, Figueiredo BC, Zambetti GP, Ribeiro RC (2005) Biology, clinical characteristics, and management of adrenocortical tumors in children. Pediatr Blood Cancer 45:265–273

    Article  PubMed  Google Scholar 

  29. Ribeiro RC, Pinto EM, Zambetti GP, Rodriguez-Galindo C (2012) The international pediatric adrenocortical tumor registry initiative: contributions to clinical, biological, and treatment advances in pediatric adrenocortical tumors. Mol Cell Endocrinol 351:37–43

    Article  CAS  PubMed  Google Scholar 

  30. Nau P, Demyttenaere S, Muscarella P, Narula V, Hazey JW, Ellison EC, Melvin WS (2010) Pheochromocytoma does not increase risk in laparoscopic adrenalectomy. Surg Endosc 24:2760–2764

    Article  PubMed  Google Scholar 

  31. Brunt LM, Lairmore TC, Doherty GM, Quasebarth MA, DeBenedetti M, Moley JF (2002) Adrenalectomy for familial pheochromocytoma in the laparoscopic era. Ann Surg 235:713–720

    Article  PubMed  PubMed Central  Google Scholar 

  32. Lenders JW, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SK, Murad MH, Naruse M, Pacak K, Young WF Jr, Endocrine Society (2014) Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 99:1915–1942

    Article  CAS  PubMed  Google Scholar 

  33. Waguespack SG, Rich T, Grubbs E, Ying AK, Perrier ND, Ayala-Ramirez M, Jimenez C (2010) A current review of the etiology, diagnosis, and treatment of pediatric pheochromocytoma and paraganglioma. J Clin Endocrinol Metab 95:2023–2037

    Article  CAS  PubMed  Google Scholar 

  34. Lopez PJ, Pierro A, Curry JI, Mushtaq I (2007) Retroperitoneoscopic adrenalectomy: an early institutional experience. J Pediatr Urol 3:96–99

    Article  PubMed  Google Scholar 

  35. Eassa W, El-Sherbiny M, Jednak R, Capolicchio JP (2012) The anterior approach to retroperitoneoscopic adrenalectomy in children: technique. J Pediatr Urol 8:35–39

    Article  PubMed  Google Scholar 

  36. Gurusamy KS, Vaughan J, Rossi M, Davidson BR (2014) Fewer-than-four ports versus four ports for laparoscopic cholecystectomy. Cochrane Database Syst Rev. doi:10.1002/14651858.CD007109

    Google Scholar 

  37. Misra MC, Aggarwal S, Guleria S, Seenu V, Bhalla AP (2008) Clipless and sutureless laparoscopic surgery for adrenal and extra-adrenal tumors. JSLS 12:252–255

    PubMed  PubMed Central  Google Scholar 

  38. Surgit O (2010) Clipless and sutureless laparoscopic adrenalectomy carried out with the LigaSure device in 32 patients. Surg Laparosc Endosc Percutan Tech 20:109–113

    Article  PubMed  Google Scholar 

  39. Kandil T, El Nakeeb A, El Hefnawy E (2010) Comparative study between clipless laparoscopic cholecystectomy by harmonic scalpel versus conventional method: a prospective randomized study. J Gastrointest Surg 14:323–328

    Article  PubMed  Google Scholar 

  40. Simforoosh N, Ahanian A, Mirsadeghi A, Lashay A, Hosseini Sharifi SH, Soltani MH (2014) Clipless laparoscopic adrenalectomy in children and young patients: a single center experience with 12 cases. Urol J 11:1228–1231

    PubMed  Google Scholar 

  41. Castilho LN, Castillo OA, Denes FT, Mitre AI, Arap S (2002) Laparoscopic adrenal surgery in children. J Urol 168:221–224

    Article  PubMed  Google Scholar 

  42. Kadamba P, Habib Z, Rossi L (2004) Experience with laparoscopic adrenalectomy in children. J Pediatr Surg 39:764–767

    Article  CAS  PubMed  Google Scholar 

  43. Steyaert H, Juricic M, Hendrice C, Lembo MA, Al Mohaidly M, Guitard J, Valla JS (2003) Retroperitoneoscopic approach to the adrenal glands and retroperitoneal tumours in children: where do we stand? Eur J Pediatr Surg 13:112–115

    Article  CAS  PubMed  Google Scholar 

  44. Kelleher CM, Smithson L, Nguyen LL, Casadiego G, Nasr A, Irwin MS, Gerstle JT (2013) Clinical outcomes in children with adrenal neuroblastoma undergoing open versus laparoscopic adrenalectomy. J Pediatr Surg 48:1727–1732

    Article  PubMed  Google Scholar 

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Author notes

    Authors and Affiliations

    1. Pediatric Surgery Unit, Women’s and Children’s Health Department, University of Padova, Padova, Italy

      Francesco Fascetti-Leon, Giovanni Scotton & Piergiorgio Gamba

    2. Department of Pediatric Surgery, Necker Enfants-Malades Hospital-Université Paris Descartes, Sorbonne Paris Cite, Paris, France

      Luca Pio & Sabine Sarnacki

    3. Pediatric Surgery, Hospital Universitario Materno Infantil, Las Palmas, Spain

      Raimundo Beltrà

    4. Pediatric Urology, Ospedale Bambino Gesù, Rome, Italy

      Paolo Caione

    5. Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University, Naples, Italy

      Ciro Esposito

    6. Pediatric Surgery Unit, Istituto Giannina Gaslini, DINOGMI University of Genoa, Genoa, Italy

      Girolamo Mattioli

    7. Paediatric Surgery Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK

      Amulya K. Saxena

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    1. Francesco Fascetti-Leon
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    Correspondence to Francesco Fascetti-Leon.

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    Disclosures

    Drs. Francesco Fascetti Leon, Giovanni Scotton, Luca Pio, Raimundo Beltrà, Paolo Caione, Ciro Esposito, Girolamo Mattioli, Amulya K Saxena, Sabine Sarnaki and Piergiorgio Gamba have no conflicts of interest or financial ties to disclose.

    Additional information

    The original version of this article was revised: The correct family name of the ninth author is “Sarnacki”.

    Francesco Fascetti Leon and Giovanni Scotton have equally contributed to this work.

    An erratum to this article is available at https://doi.org/10.1007/s00464-017-5689-4.

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    Fascetti-Leon, F., Scotton, G., Pio, L. et al. Minimally invasive resection of adrenal masses in infants and children: results of a European multi-center survey. Surg Endosc 31, 4505–4512 (2017). https://doi.org/10.1007/s00464-017-5506-0

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