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H. A. H. Ahmed et al.
D. Advances in surgical techniques have improved the treatment of malignant
adrenal tumors.
E. Decision-making regarding laparoscopic resection should account for the
malignancy potential of adrenal tumors.
Answer: C
Explanation: Laparoscopic adrenalectomy has higher recurrence rates
compared to open surgery for malignant adrenal tumors.
25. A patient with an advanced adrenal carcinoma that has inltrated the adrenal
vein and extended into the inferior vena cava is evaluated for surgery. Which of
the following statements about the surgical management of advanced malignant
adrenal tumors is incorrect?
A. Advanced adrenal carcinomas may require caval or cavo-atrial
thrombectomy.
B. Aggressive surgical approaches justify the poor prognosis without resection
or incomplete tumor resections.
C. Radical surgery includes multivisceral resections if necessary.
D. Open surgery is not recommended for tumors with cavo-atrial involvement
due to high complication rates.
E. The extent of vascular involvement classies into four types, requiring
increasingly challenging surgical procedures.
Answer: D
Explanation: Open surgery is not recommended for tumors with cavo-
atrial involvement due to high complication rates.
26. A 45-year-old patient with a small benign adrenal tumor is discussing surgical
options. Which of the following statements about the surgical approach to adrenal tumors is incorrect?
A. Laparoscopic adrenalectomy is the rst-choice treatment for small-to-
medium benign adrenal tumors.
B. Robotic adrenalectomy has gained popularity and has outcomes compara-
ble to laparoscopy.
C. The open approach is the preferred method for treating adrenocortical can-
cer, especially with neighbor tissue involvement.
D. Minimally invasive techniques are favored for large malignant adrenal
tumors without any radiological signs of malignancy.
E. Recent evidence suggests caution in treating localized adrenocortical carci-
noma with laparoscopy due to higher rates of local or peritoneal recurrence.
Answer: D
Explanation: Minimally invasive techniques are favored for large malignant adrenal tumors without any radiological signs of malignancy. This
statement is incorrect as the open approach is preferred for large tumors and
adrenocortical cancer with potential neighbor tissue involvement.
27. A patient with a large adrenal tumor is being evaluated for potential surgery.
Which of the following statements regarding the approach to large adrenal
tumors is incorrect?
16 Adrenal Tumors
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245
A. Recent guidelines recommend an individual approach rather than a clear
size cutoff for surgery.
B. Tumor size of more than 4cm in diameter represents high specicity for the
diagnosis of a malignant tumor.
C. The decision about surgery should not be based only on the size of a tumor.
D. Imaging studies, growth patterns, and urine/serum steroid metabolomics are
important in assessing the risk of malignancy.
E. Patients with LATs should be managed by an expert multidisciplinary team.
Answer: B
Explanation: Tumor size of more than 4cm in diameter represents high
specicity for the diagnosis of a malignant tumor. This statement is incorrect as the specicity for malignancy based on size alone is relatively low,
indicating the importance of a comprehensive assessment.
28. A surgical team is considering laparoscopic adrenalectomy for a patient with a
metastatic tumor to the adrenal gland. Which of the following statements about
laparoscopic adrenalectomy for malignancy is incorrect?
A. Laparoscopic adrenalectomy is safe and effective for metastatic colorectal,
lung, and renal tumors.
B. Radical resections for primary adrenal malignancies can be effectively per-
formed laparoscopically.
C. The laparoscopic technique is recommended for all primary adrenal malig-
nancies to ensure minimal invasiveness.
D. Technical advances and increased experience have expanded the indications
for laparoscopic surgery in malignant cases.
E. Long-term follow-up is needed to establish the minimally invasive tech-
nique as the preferred approach for primary adrenal malignancies.
Answer: C
Explanation: The laparoscopic technique is recommended for all primary adrenal malignancies to ensure minimal invasiveness. This statement
is incorrect as the article suggests cautious consideration of laparoscopic
surgery for primary adrenal malignancies, ensuring complete tumor resection with an intact capsule.
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