Open surgery for huge adrenal tumors: clinical report of 44 cases

Objective To summarize the experience in open surgery for huge adrenal tumors in order to improve its safety and efficiency of this complicated surgical procedure. Methods Fortyfour consecutive patients with huge adrenal tumors underwent open surgery with mean long tumor diameter of 13 cm (9-34 cm), and autologous blood transfusion was prepared in routine. It was analyzed retrospectively for clinical data, perioperative complications and the effective and safety results of this procedure. Results The incision was oblique in lumbar region in 5 cases, subcostal unilaterally in 32 cases and abdomino-thoracic joint in 7 cases. There were 27 malignant tumors (61.4%) in 44 cases, 3 with hepatic invasion, 6 with thrombi extending into inferior vena cava, among which 2 needed translocation of artificial blood vessels and 3 needed cardio-pulmonary bypass. The mean blood loss was 1309 ml (100-3000 ml) in 41 cases(93.2%)and the autologous blood transfusion was used in 20 case (45.5%). There were 1 diaphragmatic injury, 1 pleura injury, 3 hemorrhage in large amount more than 15 000 ml and 2 peritoneal cavity infection.There were no perioperative deaths and 42 tumors (95.5%) were curatively resected. Conclusions Open surgery for huge adrenal tumors is a complicated surgical technique with high risk and large amount of blood loss. The key points to success are proper selection of incision, routine autologous blood transfusion, perfect surgical skills and good cooperation between different specialties. Key words: Adrenal neoplasms;  Open surgery;  Adrenalectomy