Open adrenalectomy for ACC
Few years ago I was invited by the British Journal of Surgery to write a review on the current management of ACC (ref 1) and more recently I wrote two reviews about open adrenalectomy (ref 2) and about surgery for patients with adrenal tumours extending into large blood vessels (ref 3). These are aimed as educational tools for surgeons involved in the care of patients such as you.
The type of questions I discuss with patients during the preoperative informed consent include:
principles of surgery for ACC - all efforts will be made to ensure the tumour is resected intact, without fracture and with good margins so that the best oncological outcome can be achieved.
extent of surgery - based on the findings on the CT/PET scan a detailed discussion will be made about the benefits of resected the tumour en-block with any surrounding organs. In the group of 65 patients operated in Oxford some patients also needed removal of the kidney (n=21) or the spleen (n=14)and/ or the tail of the pancreas (n=6). These figures give a idea of the the likelihood for such extensive operation.
risks of surgery - bleeding is the most significant risk. A good preoperative planning and careful surgical technique can mitigate this risk but the possibility of needing a blood transfusion remains. When deemed beneficial I use the cell-saver (i.e. a specialised equipment that retrieves blood lost during the operation and recirculates into the patient so that the amount of blood transfused from another patient to be reduced as much as possible). Apart of bleeding, there is a risk of postoperative respiratory distress as the type of incision used makes breathing difficult - this is risk is reduced by using effective pain control (e.g. epidural analgesia or wound catheters)