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Funktionserhaltende Adrenalektomie bei Nebennierentumoren

Function-preserving adrenalectomy for adrenal tumors

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Zusammenfassung

Durch organerhaltende Resektion (subtotale Adrenalektomie) oder adrenokortikale Autotransplantation kann bei bilateraler Nebennierenchirurgie die adrenokortikale Stresskompetenz erhalten werden. Bei der adrenokortikalen Autotransplantation beträgt die Erfolgsrate ca. 30%, bei der organerhaltenden Resektion dagegen mindestens 80%. Bei organerhaltenden Resektionen bei sekundären oder familiären Erkrankungen ist jedoch das Risiko der Rezidiventwicklung zu berücksichtigen: Bei familiären Phäochromozytomen muss innerhalb von 20 Jahren mit einer Rezidivrate von bis zu 20% gerechnet werden. Nach subtotaler Adrenalektomie sollte auf die routinemäßige Gabe von Kortison verzichtet werden, da dadurch die Restitution des Restgewebes gehemmt werden kann. Allerdings muss beachtet werden, dass ca. 80% dieser Patienten zunächst eine eingeschränkte adrenokortikale Stresskompetenz aufweisen. Im Laufe weniger Wochen kommt es jedoch bei bis zu 80% der Patienten zu einer ausreichenden Erholung der Stressfunktion. Organerhaltende Nebennierenoperationen sollten endoskopisch erfolgen. Der Organrest sollte möglichst nicht devaskularisiert werden, die Nebennierenvene kann allerdings problemlos durchtrennt werden. Ein Drittel einer normalen Nebenniere ist in den meisten Fällen für eine suffiziente Nebennierenrindenfunktion ausreichend.

Abstract

Organ preserving resection (subtotal adrenalectomy) or adrenocortical autotransplantation can preserve adrenocortical stress capacity in bilateral adrenal surgery. After adrenocortical autotransplantation approximately 30% of patients do not need exogenous steroids. Organ preserving surgery avoids steroid supplementation in more than 80% of cases. After organ preserving resections in secondary or familial diseases, however, there is a relevant risk of recurrent disease: the rate of ipsilateral recurrence in familial pheochromocytoma is approximately 20% during a follow-up of 20 years. Routine administration of exogenous steroids should be avoided after subtotal adrenalectomy as functional restitution of the residual tissue might be disturbed. Approximately 80% of patients, however, present with impaired adrenocortical stress capacity directly after surgery. Within a few weeks some 80% of patients show a sufficient functional restitution of the adrenocortical stress capacity. Organ preserving adrenal surgery should be performed endoscopically. The adrenal remnant should not be devascularized; the adrenal vein, however, can be divided without functional consequences. About one third of a normal adrenal gland usually provides sufficient adrenocortical function.

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  1. Department of Surgical Sciences, University of Bergen, Jonas Lies vei 65, 5021, Bergen, Norway

    M. Brauckhoff

  2. Department of Surgery, Haukeland University Hospital, Haukeland, Norway

    M. Brauckhoff

  3. Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Halle, Halle, Deutschland

    H. Dralle

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Correspondence to M. Brauckhoff.

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Brauckhoff, M., Dralle, H. Funktionserhaltende Adrenalektomie bei Nebennierentumoren. Chirurg 83, 519–527 (2012). https://doi.org/10.1007/s00104-011-2192-7

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