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The safety and efficacy of laparoscopic adrenalectomy in children
Erik D Skarsgard1, Craig T Albanese
1Division of Pediatric General Surgery, British Columbia Children's Hospital, Vanvouver, Canada. eskarsgard@cw.bc.ca
Insights
Laparoscopic adrenalectomy (LA) is safe and effective for pediatric adrenal masses. This study shows successful outcomes in children, supporting its use for benign and selected malignant conditions.
Area of Science:
- Pediatric Surgery
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Laparoscopic adrenalectomy (LA) is standard for adult adrenal masses.
- Its use in children is less defined due to mass variability and size constraints.
- Pediatric adrenal masses require careful consideration for surgical approach.
Purpose of the Study:
- To evaluate the safety and efficacy of lateral, transperitoneal LA in children.
- To identify optimal patient selection criteria for pediatric LA.
- To assess outcomes of LA for pediatric adrenal masses.
Main Methods:
- A combined case series of pediatric patients undergoing LA between March 1999 and November 2004.
- Included children with pathologic adrenal masses at urban tertiary referral pediatric teaching hospitals.
- Primary outcomes: operative duration, conversion rates, complications, hospital stay, and disease recurrence.
Main Results:
- 21 LAs performed in 20 pediatric patients (mean age 6.4 years).
- Nine patients (43%) had neuroblastic tumors; one conversion to open surgery for adrenal carcinoma with tumor thrombus.
- No perioperative complications or blood transfusions; average hospital stay 1.5 days; no disease recurrence at follow-up.
Conclusions:
- Laparoscopic adrenalectomy is a safe and effective treatment for pediatric adrenal masses.
- The procedure is suitable for both suspected benign and selected malignant adrenal conditions in children.
- LA offers a minimally invasive option with favorable outcomes for pediatric patients.
Hypothesis:
Laparoscopic adrenalectomy (LA) has become standard therapy for benign adrenal masses in adults. The utility of LA in children with adrenal masses is less well defined because of the infrequency and pathologic variability of pediatric adrenal masses, and body size and instrumentation considerations that exist in small children. Evaluation of a case series of children undergoing lateral, transperitoneal LA will reflect the safety and efficacy of this procedure in pediatric patients and identify preferred patient selection criteria.
Design:
A combined case series including patients treated between March 1999 and November 2004.
Setting:
Urban tertiary referral pediatric teaching hospitals.
Patients And Interventions:
All children with pathologic adrenal masses undergoing LA were included.
Main Outcome Measures:
The primary study outcome measures included operative duration, conversions to open adrenalectomy, complications, length of hospital stay, and freedom from recurrence of the original pathologic adrenal mass.
Results:
A total of 21 LAs (including a staged, bilateral LA) were performed in 20 patients (13 girls, 7 boys) with a mean age of 6.4 years (range, 14 months to 18 years). Nine patients (43%) had neuroblastic tumors. Operative duration averaged mean +/- SD 101 +/- 48 minutes, and there was a single conversion to open adrenalectomy in a patient with a left adrenal carcinoma and tumor thrombus extending into the renal vein. There were no perioperative complications, and no patients required blood transfusions. The postoperative hospital stay averaged 1.5 days (range, 1-4.5 days). At a mean +/- SD follow-up of 31 +/- 17 months, all patients remained clinically (radiologically and/or biochemically) free of their original adrenal disease.
Conclusion:
Laparoscopic adrenalectomy can be used to safely treat suspected benign and selected malignant adrenal masses in children.