Algoritmo decisionale e terapeutico negli incidentalomi surrenalici Micaela Piccoli Micaela Piccoli Divisione di Chirurgia Generale (Primario: Prof. Gianluigi Melotti) Ospedale Sant’Agostino Modena, Italia Scuola Speciale ACOI di Chirurgia laparoscopica e mini- invasiva (Direttore: Prof. Gianluigi Melotti) www.acoi.it XXIV CONGRESSO NAZIONALE ACOI 25/28 Maggio 2005 - Montecatini Terme
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Algoritmo decisionale e terapeutico negli incidentalomi surrenalici Micaela Piccoli Divisione di Chirurgia Generale (Primario: Prof. Gianluigi Melotti)
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Algoritmo decisionale e terapeutico
negli incidentalomi surrenalici
Algoritmo decisionale e terapeutico
negli incidentalomi surrenalici
Micaela PiccoliMicaela Piccoli
Divisione di Chirurgia Generale(Primario: Prof. Gianluigi Melotti)
Ospedale Sant’AgostinoModena, Italia
Scuola Speciale ACOI
di Chirurgia laparoscopica e mini-invasiva
(Direttore: Prof. Gianluigi Melotti)
www.acoi.it
XXIV CONGRESSO NAZIONALE ACOI25/28 Maggio 2005 - Montecatini
Terme
NIH Consensus and State-of-the Science Statements
2002, Feb 4-6;9(2);1-25
NIH Consensus and State-of-the Science Statements
2002, Feb 4-6;9(2);1-25
Management of the ClinicallyManagement of the Clinically Inapparent Adrenal MassInapparent Adrenal Mass
(“Incidentaloma”)(“Incidentaloma”)
Management of the ClinicallyManagement of the Clinically Inapparent Adrenal MassInapparent Adrenal Mass
(“Incidentaloma”)(“Incidentaloma”)
IncidentalomaIncidentaloma
• Ormonalmente attivo o non funzionante ?• Benigno o maligno ?
• Se funzionante: surrenalectomia• Se non funzionante:
– > 6 cm surrenalectomia; – < 4 cm (senza sospetti nell’imaging) monitoraggio– 4-6 cm ?
Quale intervento?Controindicazioni all’appproccio laparoscopico?
Quale intervento?Controindicazioni all’appproccio laparoscopico?
• Laparoscopic adrenalectomy is also effective and safe for large lesions….The risk of encountering an incidental adrenal cortical cancer is significantly increased for large lesions, and therefore, in these cases, additional attention is required to observe oncologic surgical principles
Urology 2002 Nov 60(5):801-5. Case-history :125 patients
Laparoscopic adrenalectomyThe size of the mass
Laparoscopic adrenalectomyThe size of the mass
Laparoscopic adrenalectomyThe size of the mass
Laparoscopic adrenalectomyThe size of the mass
Does tumor eterogeneity limit the use of the Weiss criteria in the evoluation
of adrenocortical tumours ?
Does tumor eterogeneity limit the use of the Weiss criteria in the evoluation
of adrenocortical tumours ?
• Adrenal incidentalomas larger than 6 cm with imaging features such as intratumoral necrosis suggestive of malignancy, should be manged as potential cancers independent of the so called Weiss criteria.
J Endocrinol Invest 2004 Jun;27 (6):565-9
AdrenalectomyAdrenalectomyIndications to laparoscopic approachIndications to laparoscopic approach