par Vannineuse, Alain
Référence Acta chirurgica Belgica (Ed. bilingue), 80, 1, page (1-9)
Publication Publié, 1981
Article révisé par les pairs
Résumé : 271 Consecutive charts of all patients who underwent a bilateral adrenalectomy from 1955 till 1974 were studied. Of those, 267 could be retained for this study. The operation was performed through a bilateral subdiaphragmatic or transabdominal approach. The postoperative corticosteroid substitution therapy did not pose grave problems. A remission was obtained in 36.2% of all cases (average 18 months, median 10 months), with 4% 5 years later. The mortality was 20.7% and is the exponent of an aggressive approach with few criteria for exclusion from surgery. Massive liver and neuron system metastases were contra-indications for surgery. When there was remission, survival was attained for 24.7 months, with a median of 20 months, and 8% at 5 years. A few survived much longer. Presently, the bilateral adrenalectomy, a major procedure, should be reversed for those women with a hormone dependent tumor. Criteria are the study of the hormone receptors or the observation of a prior remission after a premenopausal oophorectomy. A multi-disciplinary approach including several types of chemotherapy can be applied to those patients for whom surgery is contraindicated.