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Background: We analyze the long‐term outcome of surgery for Cushing's syndrome (CS) and the influence of the extent of surgical resection on the duration of postoperative cortisone substitution. Methods: One‐hundred forty‐one patients (129 female, 12 males; mean age: 45.7 ± 12.8 years) operated between January 2000 to June 2020 were included in the analysis. Patients suffered from manifest (124) or subclinical (17) CS due to benign unilateral adrenal neoplasia. All tumors were removed by the posterior retroperitoneoscopic approach. 105 patients had total (TA) and 36 partial (PA) adrenalectomies. All patients were discharged with ongoing corticosteroid supplementation therapy. Results: Follow‐up data could be obtained for 83 patients. Twenty‐four (1 male, 23 females; mean age 42.3 years) underwent PA and 59 TA (6 males, 53 females; mean age 44.6 years). Mean follow‐up time was 107 ± 68 months (range: 6–243 months). The median duration of postoperative corticosteroid therapy was 9.5 months after PA and 11 months after TA (p = 0.1). Significantly, more patients after total adrenalectomy required corticosteroid therapy for more than 24 months (25% vs. 4%; p = 0.03). Recurrent ipsilateral disease occurred in one case after partial adrenalectomy and was treated by completion adrenalectomy. A case of contralateral recurrence associated with subclinical Cushing's syndrome was observed after total adrenalectomy. Conclusions: The risk of local recurrence after partial adrenalectomy in CS is low. Cortical‐sparing surgery may shorten corticosteroid supplementation therapy after surgery. [ABSTRACT FROM AUTHOR]

OBJECTIVE To evaluate the outcomes and timing of intervention for adrenal-sparing surgery in patients left with a solitary adrenal remnant after bilateral adrenal surgeries. PATIENTS AND METHODS Patients were included in the study if they had undergone bilateral adrenal surgery as a treatment for phaeochromocytoma and were left with a solitary adrenal remnant. Perioperative, functional and oncological outcomes were evaluated in 21 patients who met the inclusion criteria. RESULTS There was minimal perioperative morbidity and no perioperative mortality. After a median (range) follow-up of 21 (3-143) months, there were two cases of persistent disease. Ten patients (48%) required steroid supplementation upon discharge, with four subsequently discontinuing this treatment. Patients were more likely to require steroid supplementation after surgery if they underwent simultaneous adrenalectomy and contralateral partial adrenalectomy, rather than staged procedures (86 vs 40%, P = 0.02). Patients who underwent surgery for tumours > 4 cm were more likely to require long-term steroids than patients who underwent surgery for lesions < 4 cm (75 vs 18%, P = 0.05). CONCLUSIONS Patients left with a solitary adrenal remnant after bilateral adrenal surgery have low surgical morbidity, reasonable functional outcomes and low rates of recurrence at an intermediate follow-up period. A staged approach could decrease the immediate postoperative need for steroids, and intervention before the largest tumour reaches 4 cm could decrease the rate of long-term steroid dependence. [ABSTRACT FROM AUTHOR]

Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To present our experience of retroperitoneoscopic partial adrenalectomy (RPA) for small adrenal tumours, as with modern imaging methods small adrenal lesions are being diagnosed more commonly, and retroperitoneoscopic adrenal surgery for small adrenal tumours (≤1 cm) can be challenging. PATIENTS AND METHODS We retrospectively reviewed the records of 389 consecutive retroperitoneoscopic adrenalectomies from September 2005 to December 2008, 88 of which were small adrenal tumours and treated by RPA. Ultrasonography and computed tomography (CT) were used in all patients before RPA, and magnetic resonance imaging or positron emission tomography/CT in some patients. We used RPA for adrenal tumours and total adrenalectomy for adrenal cancer. During the surgery, the internal part of the adrenal gland close to the retroperitoneum was freed first, and the whole adrenal tissue was dissected completely. The preoperative imaging was important in these procedures. RESULTS There were no deaths; conversions to open surgery were necessary in four patients (4.5%), the reasons being a missing target in two, massive haemorrhage caused by central adrenal vein injury in one, and severe adhesion in one. The mean (range) size of the adrenal tumours was 0.7 (0.5–1.0) cm, including 69 aldosterone-producing adenomas, 11 nonfunctional adrenal adenomas, three Cushing syndrome, two phaeochromocytomas, two myelolipomas and one melanoma. The operative duration in the initial 38 cases was significantly longer than that in the subsequent 50 ( P < 0.01). However, there was no significant correlation between estimated blood loss and the number of procedures. Tumour size did not correlate with estimated blood loss and operative duration. There was no significant correlation between body mass index and operative duration. CONCLUSION RPA is a safe, effective and minimally invasive therapeutic option for patients with small adrenal tumours. With improved operative technique the RPA has been completed in more quickly. Freeing the internal part of the adrenal gland close to the retroperitoneum first, and exploring the whole adrenal tissue during surgery are the key points of RPA. The location of the small adrenal tumour can be different from that shown on imaging before surgery, and the abnormality of the adrenal gland should be considered. [ABSTRACT FROM AUTHOR]