The Application of Hybrid OR in the Surgery for Multiple-times Recurrence of Adrenal Cortical Carcinoma
Po-Hung Lin, Hung-Cheng Kan, Jacob See-Tong Pang, Kai-Jie Yu
Division of Urology, Department of surgery, Chang Gung Memorial Hospital at Linkou
Purpose: The gold standard treatment for adrenal cortical carcinoma (ACC) is surgical resection followed by adjuvant Mitotane or chemotherapy. However, patient may encounter recurrence under adjuvant therapy. In this situation surgical resection is still the main treatment. For patients with multiple-times recurrence, the surgery is difficult due to adhesion resulted from previous surgeries and patient may suffer more since open surgery is usually needed.
Materials and Methods: We reported the initial experience of intra-operative computed tomography (CT)-guided localization for a patient with third time recurrence from ACC. The patient received laparoscopic resection of primary ACC, laparoscopic resection for the first recurrence and laparotomy for the second time. For third recurrence we used the Zeego system to localize the recurrent tumor via retroperitoneoscopic approach.
Results: We used the Zeego system to plot the suggested route for needle-localization. However, due to high position of the tumor, the route may penetrate pleural cavity and result in pneumothorax. Instead, we use the laparoscopic instruments as a reference probe and localized the tumor with the relative position between the tumor and the instruments. We successfully localized the tumor and resected it. The patient was discharged 3 days after the surgery and the final pathology revealed recurrent ACC.
Conclusions: Our initial experience showed that intraoperative localized with CT is useful for patients with recurrence tumors. Further applications should be investigated for the urological surgeries.