The surgical management of adrenal tumors is a very unusual and highly specialized practice. It is critically important that your operating surgeon have extensive experience with the myriad of biochemical presentations, syndromes and technical aspects of adrenal surgery. Often, these patients are evaluated incompletely, which sometimes leads to incorrect treatment. Further, few surgeons, such as Dr. Kaynan, are willing to tackle certain pheochromocytomas or cancer cases laparoscopically. The peri-operative management of these tumors is highly specialized as well, and the smallest misses may result in disastrous complications. Dr. Kaynan works closely, as needed, with a team of medical oncologists, endocrinologists and intensive care specialists to handle these cases.
Most benign non-functional adenomas of the adrenal gland are small and simply observed over time by serial imaging (eg, CAT scans). Functional tumors of any kind, which are usually small, are typically removed because of their great propensity to disrupt normal regulatory functions of the body. Large tumors are considered to be cancerous and are removed regardless of functionality.
While there is some controversy over what size triggers removal of the adrenal gland, Dr. Kaynan uses 5cm as a cutoff (ie, adrenal tumors 5cm or larger are recommended to removal). Also, adrenal tumors demonstrating rapid growth during surveillance are subject to removal.
Adrenal tumors may be removed using open, laparoscopic or robotic methods. Most adrenal tumors may be removed using the laparoscopic method. Even some carefully selected cancers, including solitary deposits from other sources and primary malignancies of the adrenal gland, may be removed using laparoscopic (minimally invasive) techniques. Only the largest adrenal tumors, or adrenal tumors demonstrating obvious aggressive local features (such as invasion into adjacent organs or lymph nodes) need resection using open methods. In Dr. Kaynan’s experience, because there is no reconstructive component to removal of the adrenal gland, robotics adds nothing to the safety or recovery profile of laparoscopic adrenalectomy. It is possibly useful for surgeons without much training in laparoscopic techniques. Dr. Kaynan routinely performs laparoscopic adrenalectomy within 2 hours, and as fast as 27 minutes. In his experience, except for possibly the morbidly obese patient, robotics adds only operative time, hassle and expense.