SIU 2017: Bilateral Laparoscopic Adrenalectomy of Salvage In Cushing Syndrome Refractory To Medical Treatment

Lisbon, Portugal ( Ectopic ACTH production is a less common (7-15%) etiology for endogenous Cushing syndrome. Treatment for patients can sometimes involve salvage bilateral adrenalectomy if surgical resection of the primary neuroendocrine malignancy is not feasible and patients had no response to medical therapy. In this study, the group from Argentina describe their clinical experience with laparoscopic bilateral adrenalectomy as a therapeutic option for this subset of patients.

This was a retrospective analysis of 4 patients who underwent bilateral LA over a 2 year period. They defined success as no conversion to open bilateral nephrectomy AND significant decrease in cortisol levels after resection. The mean age was 40, but ranged from 23-50. Three of the four patients were women. BLA was successfully completed, without conversion to open approach in any patient. While there were no intraoperative complications, two patients had postoperative complications – neither was Grade 3-5. Average hospital stay was 28 days (4 – 81 days range). Mean operative time was very variable – median was 245 minutes (range 137 minutes to 390 minutes). Three were transperitoneal and one was retroperitoneal; the RP approach had the shortest operative time of 137 minutes. From a clinical standpoint, all four patients had good cortisol response; all four patients had resolution of hypercortisolism.

With any case series of just four patients, hard conclusions are hard to make. However, this group appears to have had technical success with bilateral LA, though some of the patients may have shorter operative time open approach. From a clinical response, they had good response. It appears to be a technically feasible option for salvage, but further study would be required in this rare disease process.

Speaker: José Ignacio Nolazco, Argentina

Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, Twitter: @tchandra_uromd at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal