Citation Information :
de Jong MC, Senanayake KJ, Jafar-Mohammadi B, Khan S, Mihai R. Severe Ectopic Cushing\'s Syndrome: Feasibility of Bilateral Simultaneous Retroperitoneoscopic Adrenalectomy and Risk of Thromboembolic Events. World J Endoc Surg 2021; 13 (1):16-19.
Aim and objective: To report our recent experience with bilateral simultaneous retroperitoneoscopic adrenalectomy for severe ectopic Cushing\'s syndrome (CS) and discuss the risk of severe thromboembolic events (TEs) in such patients.
Background: Patients with CS have an increased risk of arterial and venous TEs. For patients with severe ectopic CS not responding to the medical blockade, bilateral adrenalectomy is indicated to relieve symptoms.
Case description: Three patients underwent a bilateral simultaneous retroperitoneoscopic adrenalectomy for severe ectopic CS. The minimally invasive procedure was completed in all patients, with total operative times ranging from 70 to 120 minutes and negligible overall blood loss. All patients developed perioperative TEs despite being on prophylactic dosages of low molecular weight heparin (5,000 U Dalteparin). Postoperative hospital stay was prolonged (6–20 days) due to complex medical needs and difficult physical rehabilitation. During follow-up (6–20 months), mobility and functional status improved significantly in all patients. All remain on daily adrenal replacement with no biochemical signs of recurrent hypercortisolism.
Conclusion: Bilateral simultaneous retroperitoneoscopic adrenalectomy for severe ectopic CS is feasible, safe, and advantageous in selected centers with sufficient surgical expertise. The risk of developing a TE for these patients is extremely high and international guidelines should be developed.
Clinical significance: The risk of development of TE for the patient with severe ectopic CS in the presence of a disseminated malignancy is extremely high. In addition to following current guidelines on anti-TE prophylaxis, we consider that all patients should undergo a formal lower limb duplex ultrasound scan at the time of initial surgical workup, to select those patients who need to be started on early therapeutic dose anticoagulation if the presence of a TE is confirmed.
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