AB063. SOH25_AB_126. Radical adrenalectomy: ten-year experience from a tertiary referral centre

Background: Adrenalectomy is performed for benign and malignant pathology with a minimally invasive approach favoured where possible. However radical open adrenalectomy remains indicated for large tumours that require multi-visceral resection or vascular reconstruction. There is currently no National Centre in the Republic of Ireland for Adrenal surgery.

Methods: A retrospective review of all patients undergoing open adrenalectomy from January 2013–December 2023 were included. Theatre logbooks, anaesthetic records and patient notes both electronic and paper based were reviewed. Minimally invasive adrenalectomies were excluded. Basic demographics, operative details, histopathology, morbidity and mortality were recorded.

Results: There were 37 open adrenalectomies performed in our institution, 51.2% were male with a median age of 50.5 years. 80% of patients were American Society of Anaesthetists (ASA) II or III and 40% underwent multi-visceral resection and 24% multi-visceral resection requiring inferior vena cava (IVC) reconstruction. The average length of procedure was 181.8 minutes. Adrenal cortical carcinoma, renal cell carcinoma and pheochromocytoma were the histopathological diagnosis in 24%, 22% and 19% respectively. R0 resection was achieved in 89% of cases. The average length of stay was 12.9 days and there were no mortalities recorded in the first 30 days. A Clavien-Dindo classification >3 morbidity was recorded in 10.8% (N=4).

Conclusions: Radical Adrenalectomy incorporating multi-visceral resection often requiring vascular reconstruction is not a commonly performed operation. When performed in a Centre with relevant experience in both hepatobiliary and transplant surgery, it is both technically feasible and oncologically sound with our institution reporting favourable negative margin (i.e., R0) rates and acceptable morbidity and mortality rates at 30 days. We would advocate for the formal establishment of a National Centre to provide a dedicated surgical service with sufficient volume, formal follow-up, survivorship support and to enhance surgical training.

Keywords: Adrenal cortical carcinoma; national centre; renal cell carcinoma; radical adrenalectomy; vascular reconstruction