Current state-of-the-art of adrenal surgery in Italy: the cancer risk in surgical adrenal lesions (CRISAL) survey

Adrenalectomies are growing worldwide because of the frequent diagnosis of incidentaloma and the use of minimally invasive surgery (MIS). The factors used to identify a malignant lesion and the best surgical technique are uncertain. In this context, the definition of high-volume center and expert surgeon is under debate. The Italian Society of Endoscopic Surgery and New Technologies (SICE) developed a nationwide survey to investigate the state-of-the-art of adrenal surgery in Italy. A web-based survey comprising 37 questions was developed and distributed to Italian surgeons involved in adrenal surgery. Two hundred forty-eight answers were analyzed. Consensus was reached among the survey participants regarding local infiltration (83%) and rapid growth of the lesion (81%) as markers of malignancy. Nearly 30% of the participants used MIS in case of malignant adrenal lesions. The lateral (50%) and anterior transperitoneal (44%) approaches were the most common among Italian surgeons. Approximately 40% of participants believe that 20-40 adrenalectomies/year are needed to define an expert surgeon and at least 20 procedures/year to define a high-volume center. Approximately half of participants performed < 10 adrenalectomies/year in centers with a median volume < 10 procedures/year. Based on participant feedback, this survey highlights local infiltration and rapid growth as the most significant markers of malignant adrenal lesions. While open adrenalectomy remains the gold standard for suspected malignant lesions, nearly 30% of the participants practice MIS even in these cases. The lateral and anterior transperitoneal approaches emerge as the most familiar for Italian surgeons. A substantial proportion of Italian patients with adrenal lesions undergo surgery performed by surgeons with an annual case volume < 10 procedures, at centers with a low annual volume of adrenalectomies. Moreover, there is a lack of standardized definitions for 'expert surgeon' and 'high-volume center' in this context.

Authors

Institutions

Publication Details

Journal
Updates in Surgery
Published
2025-03-17
DOI
https://doi.org/10.1007/s13304-025-02139-8
Primary Topic
Adrenal and Paraganglionic Tumors
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Current state-of-the-art of adrenal surgery in Italy: the cancer risk in surgical adrenal lesions (CRISAL) survey

Filippo Banchini, Mariarita Tarallo, Marco Anania, Alberto Patriti et al.
Updates in Surgery
Adrenal and Paraganglionic Tumors
article

Current state-of-the-art of adrenal surgery in Italy: the cancer risk in surgical adrenal lesions (CRISAL) survey

Filippo Banchini, Mariarita Tarallo, Marco Anania, Alberto Patriti, Alessandro Ussia, Samantha Vellei, Giuseppe Cavallaro, Silvana Leanza, Alessandra Micalizzi, Raffaele Galleano, Sara Lauricella, Massimiliano Ardu, Giulia Bagaglini, Luca Tirloni, Bruno Sensi, Nicolò de Manzini, Greta Olivari, Giuseppe Buono, Francesco Maria Carrano, Riccardo Avantifiori, Michele Ammendola, Luigi Luzza, Francesca Abbatini, Niccolò Furbetta, Michele Minuto, Alberto Sartori, Sara Lucchese, L Bonomo, Nirvana Maroni, Federica Saraceno, Monica Ortenzi, Tommaso Guagni, Simone Guadagni, Giuseppe Massimiliano De Luca, Roberta Angelico, Fabio Pelle, Marco Materazzo, Alessandro M. Paganini, Alessia Fassari, Stefano D’Ugo, Mauro Podda, Giuseppe Frazzetta, Ilaria Puccica, Maurizio Zizzo, Francesco Brucchi, Andrea Martina Guida, Giovanni Maria Garbarino, Giuseppe Palomba, Serena Molica, Giuseppe Currò, Giulio Iacob, Laura Alberici, Priscilla Francesca Procopio, Antonella Nicotera, Livia Palmieri, Valeria Usai, Michail Vailas, Paolo Vincenzi, Teresa Perra, Luigi Eduardo Conte, Marta Spalluto, Paolo Ossola, Antonio Vitiello, Gianmaria Casoni Pattacini, Francesca Meoli, Luca Morelli, Ugo Giustizieri, Chiara Fantozzi, Andrea Divizia, Salomone Di Saverio, Luca Cardinali, Lucrezia Clocchiatti, Stefano Rossi, Bruno Perotti, Gianluca Cassese, Paolino De Marco, Daniele Zigiotto, Alberto Porcu, Gianluca Vanni, Barbara Mullineris, Andrea Lucchi, Sara Ingallinella, Riccardo Marsengo, Tommaso Fontana, E Baldini, Pasquale Cianci, Giovanni Conzo, Ferdinando Agresta, Antonio Castaldi, Andrea Balla, Mihail Creciun, Stefano Agnesi, Omar Ghazouani, Maria Rosaria Valenti, Stefano Olmi, Giulio Argenio, Manuela Mastronardi, Gaetano Poillucci, Arianna Birindelli, Giuseppe Giuliani, Giovanni Scudo, Filippo Carannante, Daniele Delogu, Stefania Angela Piccioni, Angela Maurizi, Emilio Eugeni, Salvatore Incardona, Sonia Cappelli, Pietro Fransvea, Francesco Bianco, Giulia Paradiso, Tommaso Maria Manzia, Pietro Maria Amodio, Felice Pirozzi, Francesco Balestra, Flavio Tirelli, Alice Francescato, Giovanni Alemanno, Federico De Stefano, Ardit Seitaj, Giuseppe Evola, Giovanna Pavone, Tommaso Campagnaro, Andrea Picchetto, Eleonora Rapanotti, Rocco Pasqua, Lorenza Beomonte Zobel, Marco Pellicciaro, Giuseppe Navarra, Francesco Pata, Sara Maritato, Oreste Claudio Buonomo, Francesco Puccetti, Mario Pacilli, Marta Celiento, Ilaria Benzoni, Pietro Anoldo, Paolo Brazzarola, Marzia Franceschilli, Alfredo Annicchiarico, Alessandro Coppola, Margherita Sandano, Irene Marziali, Giulia Pietricola, Marianna Capuano, Belinda De Simone, Jacopo Andreuccetti, Ernesto Tartaglia, Lorenzo Provinciali, Domenico Tamburrino, Luca Lepre, Riccardo Rosati, Ugo Elmore, Marco Clementi, Amedeo Antonelli, David Merlini, Gian Luca Baiocchi, Salvatore Fazzotta, Francesco Giovanardi, Sofia Usai, Cristina Bombardini, Enza Gelormini, Sara Dedoni, Andrea Pisani Ceretti, Francesco Roscio, Marco Giacometti, Leandro Siragusa, Alessio Giordano, Vittorio Cherchi, Anna D’Amore, Francesco Pennestrì, Irene Fiume, Roberto Cammarata, Nicola Tartaglia, Agostino Fernicola, Zoe Larghi Laureiro, Paolina Saullo, Elisa Cassinotti, Niccolò Petrucciani, Anna Guariniello, Giorgio Dalmonte, Elisa Bannone, Mario M. Annecchiarico, Laura Fortuna, Filippo Petrelli, Bruno Nardo, Gianluca Fornoni, Francesco Frattini, Alberto Balduzzi, Nicolò Falco, Samuele Vaccari, L. Ottaviani, Paolo Pizzini, Chiara Piceni, Marco Inama, E. Lodo, Domiziana Pedini, Marta Botti, Leonardo Rossi, Graziano Ceccarelli, Biagio Picardi, Maria Vittoria D’Addetta, Diletta Corallino, Maurizio De Luca, Fausto Catena, Sarah Molfino, Nicola Di Lorenzo, Bruno Cirillo, Federico Maggi, Giacomo Di Filippo, Pierluigi Angelini, Giacomo Calini, Michele De Capua, Roberto Passera, Giovanni Terrosu, Vito Pende, Gennaro Mazzarella, Carmen Maccagnano, Antonia Rizzuto, Diego Cuccurullo, Giovanni Cestaro, Vincenzo Papagni, Annalisa Comandatore, Edoardo Forcignanò, Diego Coletta, Marco E. Allaix, Andrea Morini, Pier Luigi Tilocca, Federico Passagnoli, Ilenia Merlini, Andrea Bottari, Maurizio Costantini, Gabriela Aracelly Arroyo Murillo, Simone Buccianti, Nicola Perrotta, Fabrizio Romano, Federico Festa, Alberto Aiolfi, Amos Éla Bella, Andrea Dato, Mattia Zambon, G. Porcu, Gabriele Carbone, Andrea Pierre Luzzi, Gregorio Di Franco, Kevin Episodio, Lorenza Trentavizi
article en

Abstract

Adrenalectomies are growing worldwide because of the frequent diagnosis of incidentaloma and the use of minimally invasive surgery (MIS). The factors used to identify a malignant lesion and the best surgical technique are uncertain. In this context, the definition of high-volume center and expert surgeon is under debate. The Italian Society of Endoscopic Surgery and New Technologies (SICE) developed a nationwide survey to investigate the state-of-the-art of adrenal surgery in Italy. A web-based survey comprising 37 questions was developed and distributed to Italian surgeons involved in adrenal surgery. Two hundred forty-eight answers were analyzed. Consensus was reached among the survey participants regarding local infiltration (83%) and rapid growth of the lesion (81%) as markers of malignancy. Nearly 30% of the participants used MIS in case of malignant adrenal lesions. The lateral (50%) and anterior transperitoneal (44%) approaches were the most common among Italian surgeons. Approximately 40% of participants believe that 20-40 adrenalectomies/year are needed to define an expert surgeon and at least 20 procedures/year to define a high-volume center. Approximately half of participants performed < 10 adrenalectomies/year in centers with a median volume < 10 procedures/year. Based on participant feedback, this survey highlights local infiltration and rapid growth as the most significant markers of malignant adrenal lesions. While open adrenalectomy remains the gold standard for suspected malignant lesions, nearly 30% of the participants practice MIS even in these cases. The lateral and anterior transperitoneal approaches emerge as the most familiar for Italian surgeons. A substantial proportion of Italian patients with adrenal lesions undergo surgery performed by surgeons with an annual case volume < 10 procedures, at centers with a low annual volume of adrenalectomies. Moreover, there is a lack of standardized definitions for 'expert surgeon' and 'high-volume center' in this context.

Updates in SurgeryVol. 77(5)
Vita-Salute San Raffaele University (IT), Policlinico Umberto I (IT), Casa di Cura Villa Garda (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT), University of Turin (IT), Sapienza University of Rome (IT)
Good health and well-being
Openalex Percentile: Top 92%
Adrenal and Paraganglionic Tumors
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.