GENEL CERRAHİ KLİNİĞİMİZDE ADRENALEKTOMİ YAPILAN HASTALARIN DEĞERLENDİRİLMESİ

Amaç2013-2018 yılları arasında Gülhane Eğitim ve Araştırma Hastanesi Genel Cerrahi ABD’de opere edilen hastaların sonuçları ve klinik deneyimimizi irdeledik.Çalışmamızda benign ve malign adrenal gland bezi hastalıkları nedeni ile Laparaskopik adrenektomi uygulanan hastalar ile açık cerrahi uygulanan hastalarınsonuçlarını ortaya koymayı amaçladık.Gereç ve YöntemAdrenal Gland kitlesi nedeni ile opere edilen 44 hastanın retrospektif olarak verilerinin sunulduğu bir çalışmadır. Hastaları yaş, cinsiyet, adrenal kitle büyüklüğü,preoperatif teşhis, operasyon şekli, final histopatoloji açısından değerlendirdik.SonuçAdrenal gland kanseri nedeniyle ameliyat edilen 28’i erkek 16’sı kadın toplam 44 hasta sunulmuştur. Hastaların yaşları 20-83 arasında değişmekte olup yaş ortalaması 45.2 ±11.7’dir. Bu şekilde 44 hastanın 30’unda (%68,18) LA, 14’ünde (%31,82) ise AA yapılmıştır. Histopatolojik incelemelerine göre değerlendirildiğinde adrenal gland kitlelerinin 33’ü (%75) AKA, NFA, adrenal cyst, Feo gibi benign hastalık iken 11’inde (%25) AKK veya metastatik adrenal gland kanseri tespit edilmiştir. Malign patolojiler nedeniyle adrenalektomi yapılan 11 hastanın 6’sı başka organların kanserine ait metastaz, 5’i ise primer AKK idi. Hastaların postoperatif dönemde hastanede yatış süresi 2-11 gün arasında değişmekte olup ortalama yatış süresi 3.3±2.5 gün olarak tespit edilmiştir.SonuçAdrenal insidentalomalar % 1–4 oranında abdominal görüntüleme çalışmalarında ortaya konulabilmektedir ve yaş ile birlikte adrenal insidentolomların görülmeriski artmaktadır. Cerrahi sürrenalektominin endikasyonları çoğunlukla non fonksiyone adenomalarveya diğer benign adrenal bez tümörleridir. Buna karşınAKK veya metastatik adrenal gland tümörleri daha az görülmektedir. Bunların rekürrens oranları daha yüksektir ve kötü prognostik seyire sahiptirler. AKK vemetastatik tümörlerin cerrahisi açık cerrahi veya bazı karşıt görüşler olmasına rağmen lalaraskopik olarak yapılabilmektedir

EVALUATION OF ADRENALECTOMISED PATIENTS IN OUR DEPARTMENT OF SURGERY

Objective In our study, we wanted to share our experience of adrenalectomy that took place at Gulhane Training and Research Hospital, Department of General Surgery between 2013-2018. Our aim was to evaluate the effect of laparoscopic adrenalectomy (LA) andopen adrenalectomy (OA) for the treatment of benign and malign adrenal gland diseases. Materials and Methods This is a retrospective case series study of 44 patients which were operated because of adrenal gland mass. We evaluate the patients according to age, sex, adrenal tumor size, preoperative diagnosis, type of operation and final histopathologic diagnosis. Results LA and OA were done 68,18%(n=30) and 31.82% (n=14) of the patients respectively. Final histopathooogical diagnosis were benign adrenal diseases including adrenocortical adenoma, non-functioning adenoma, pheochromocytoma, adrenal hyperplasia, myelolipoma, adrenal cyst in 33(75%) patients. Five patients (11,3%) were adrenocortical carcinoma (ACC) and six (%13,6) patients were diagnosed as metastatic adrenal gland tumors as renal clear cell carcinom, lung small-cell carcinom, gastrointestinal stromal tumors (GIST) and mixt germ cell tumour of testis metastasis. Hospitalization duration was 3.3±2.5 days and there was no postoperative morbidity/mortality. Discussion Adrenal incidentalomas are identified in 1–4% of abdominal imaging studies, and the incidence of adrenal incidentaloma increases with age. Most common indication for adrenalectomy is non-functioning adenoma and other benign adrenal tumors. But ACC or metastatic adrenal gland tumors are rare diseases with high recurrence rate and poor prognosis and their surgical treatment could be done OA or LA in spite of some controversy

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