童綜合醫院 外科部 泌尿科
Robot-assisted laparscopic radical adrenalectomy for adrenocortical carcinoma
Chao-Yu Hsu, Wei-Chun Weng, Jue-Hawn Yin, Hao-Ping Tai, Hsiang-Lai Chen, Siu-San Tse, Zhon-Min Huang, Min-Che Tung
Divisions of Urology, Department of Surgery, Tungs’ Taichung Metro Harbor Hospital, Taichung, Taiwan
The incidence of adrenocortical carcinoma (ACC) is very rare. The estimated incidence was about 0.5 to 2 new patients per million people per year. Complete resection is the standard treatment of all patients with localized stage I-II and local advanced stage III ACCs. But the prognosis is poor in locally advanced, inoperable and metastatic ACCs. Early interventions (complete resection, post operation immediate chemotherapy) will achieve better outcomes.
The case is a 71 year-old woman. At presentation, he got hypertension with regular medicine (Dilatrend and Caduet) but had suboptimal blood pressure control for more 7 years. She was arranged to have ultrasound of abdomen and showed an about 6 cm left adrenal tumor with central necrosis. Biochemistry data showed elevation of aldosterone (77.28 ng/dL, normal range: 3.7-24), vanillylmandelic acid (33.8 mg/24hrs, normal range: 1-7.5) and Cortisol (27.5 ug/day, normal range: 5-25). After robot-assisted laparoscopic left adrenalectomy, she achieved a two months normalized blood pressure without medicine for hypertension. Her blood pressure was also normalized. (aldosterone 77.28 ng/dL, vanillylmandelic acid 4.3 ng/dL)
Reviewed our patient’s history and literatures, she will have good outcome of blood pressure control and tapering of hypertension drugs. It is also compatible with normalization of biochemistry data. Her adrenal tumor is functional adrenal cancer and was response on optimal blood pressure control an normalization of biochemistry control. Her specimen showed intact capsule and only < 4% K-i67 was positive. This case is not good candidate for neoadjuvant systemic chemotherapy with Mitotane or postoperative radiotherapy. However, regular image surveillance is imperative, it includes regular fllow-up of abdominal CT (or MRI), thoracic CT and monitoring of initially elevated steroids.