[Are there still indications for open adrenalectomy?]

Area of Science:

• Surgical Oncology
• Endocrinology
• Visceral Surgery

Background:

• Minimally invasive techniques are prevalent in adrenal surgery.
• Open adrenalectomy is a vital component of surgical options for adrenal pathologies.

Purpose of the Study:

• To define the indispensable indications for open adrenalectomy.
• To highlight the necessity of open adrenalectomy in specific adrenal tumor scenarios.

Main Methods:

• Review of indications for open adrenalectomy in adrenal surgery.
• Analysis of clinical scenarios necessitating open adrenalectomy over minimally invasive approaches.

Main Results:

• Open adrenalectomy is indicated for advanced adrenal carcinoma (ENSAT stage III), including cases with local infiltration, venous thrombosis, or lymph node metastases.
• It is also considered for adrenocortical carcinoma (ENSAT stages I-II) and large, suspicious adrenal tumors (6-8 cm, Hounsfield units > 20) without clear preoperative malignancy.
• Other adrenal pathologies like neuroblastomas, large pheochromocytomas, and schwannomas may also warrant open adrenalectomy.

Conclusions:

• Open adrenalectomy remains a necessary procedure for specific complex adrenal conditions.
• Its indications extend beyond advanced cancers to include large, indeterminate adrenal masses and certain benign tumors requiring extensive resection.