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Open Access Research article

Preoperative workup in the assessment of adrenal incidentalomas: outcome from 282 consecutive laparoscopic adrenalectomies

Mario Musella1*, Giovanni Conzo2, Marco Milone1, Francesco Corcione3, Giulio Belli4, Maurizio De Palma5, Annunziato Tricarico6, Luigi Santini2, Antonietta Palazzo2, Paolo Bianco1, Bernadette Biondi7, Rosario Pivonello7 and Annamaria Colao7

Author Affiliations

1 General and Emergency Surgery, “Federico II” University, Naples, Italy

2 General and Endocrine Surgery, Second University “SUN”, Naples, Italy

3 General and Laparoscopic Surgery, AORN “Monaldi” Hospital, Naples, Italy

4 General Surgery, “S. Maria di Loreto Nuovo” Hospital, Naples, Italy

5 General and Endocrine Surgery, AORN “A. Cardarelli” Hospital, Naples, Italy

6 General and Emergency Surgery, AORN “A. Cardarelli” Hospital, Naples, Italy

7 Endocrinology, “Federico II” University, Naples, Italy

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BMC Surgery 2013, 13:57  doi:10.1186/1471-2482-13-57

Published: 27 November 2013

Abstract

Background

To confirm the efficacy of preoperative workup, the authors analyse the results of a multicentre study in a surgical series of patients diagnosed with an adrenal incidentaloma.

Methods

The retrospective review of a prospectively collected database was conducted. The data was obtained by six surgical units operating in the Campania Region, Italy. Five-hundred and six (506) adrenalectomies performed between 1993 and 2011 on 498 patients were analysed. Final histology in patients with a preoperative diagnosis of incidentaloma and studied according to guidelines (230/282 patients group A) was compared with final histology coming from patients presenting the same preoperative diagnosis but studied not according to guidelines (52/282 patients group B).

Results

In group A preoperative diagnosis was confirmed at final histology in 76/81 (93.8%) cases of subclinical functioning lesions presenting as an incidentaloma. The preoperative detection of pheochromocytoma and primary adrenocortical cancer (ACC) reached 91.6% and 84.6% respectively. In group B conversion rate to open surgery was higher than in group A (p = 0.02). One pheochromocytoma was missed at preoperative diagnosis whereas one ACC smaller than 4 centimetres (cm) and coming from an incidental lesion was discovered. In both groups a significant association between increasing dimensions of incidentaloma and cancer has been observed (p = 0.001).

Conclusions

This surgical series confirm the high efficacy of suggested guidelines. A significant preoperative detection rate of adrenal lesions presenting as incidentaloma is observed. The unnecessary number of adrenalectomies performed in understudied patients, causing higher morbidity, was not associated to a higher detection rate of primary adrenocortical cancer.

Keywords:
Laparoscopic adrenalectomy; Incidentaloma; Adrenocortical cancer; Preoperative workup; Pheochromocytoma; Guidelines