Laparoscopic adrenalectomy for large adrenal masses: Is it really more complicated?

Abstract

Laparoscopic treatment of large adrenal tumors is still questionable due to concern over the risk of malignancy as well as the technical difficulties. No exact dimensional cut-off has been described for laparoscopic adrenalectomy (LA). In this study, we reviewed our experience with LA for masses ≥ 8 cm and tried to determine the limitations of this surgery in this group of patients. Sixteen patients with adrenal mass ≥ 8 cm (Group 1) and 19 patients with adrenal mass < 8 cm (Group 2) treated with transabdominal LA were included in this study. We analyzed operative time, intraoperative and postoperative complications and length of postoperative hospital stay with respect to tumor size and clinopathologic features. Mean maximum tumor diameters were 91.7 mm (range, 80-150 mm) and 52.4 mm (range, 35-73 mm) in Group 1 and Group 2, respectively. Operation time and blood loss were higher in Group 1 compared to Group 2, but these differences did not reach significant levels (p>0.05). Conversion to an open procedure required in two patients, one from each group, because of the firm attachments of adrenal mass to the surrounding tissue. In conclusion, our study demonstrated that LA is a safe and feasible procedure for large lesions even up to 15 cm. The risk of finding incidental adrenal cortical cancer was significantly increased for large lesions in our series as in the literature; therefore, it is important to follow the strict oncological principles in these cases.

Retroperitoneal laparoscopic adrenalectomy with transient renal artery occlusion for large adrenal tumors (≥8 cm)

“…The average operative time, estimated blood loss, perirenal drainage time, postoperative hospital stay, postoperative drainage, and transfusion rate were 176.3 ± 49.7 min, 247.2 ± 274.1 mL, 4.1 ± 1.02 days, 6.3 ± 1.4 days, 73.6 ± 47.9 mL, and 1/18, respectively. Compared with those in a previous study in which patients with large adrenal tumors (8 cm) underwent LTA, the operative time and hospitalization time were longer and the blood loss was greater, but complications such as conversion to OA and blood transfusion were reduced (Table ) . Moreover, Insang et al evaluated the surgical feasibility of RLA for tumors ≧5 cm and found that the operative time, estimated blood loss, postoperative hospital stay, transfusion, and surgical complications were 214.54 ± 76.04 min, 367.24 ± 275.11 mL, 9.26 ± 3.10 d, 6 (7.9%), and 13 (17.1%) respectively, for large adrenal tumors (7.10 ± 2.15 cm) (Table ) .…”

“…First 6 cm and then 8 cm was regarded as the upper limit size for LA . Subsequently, another study suggested that laparoscopic transabdominal adrenalectomy (LTA) had similar effects on adrenal masses ≥8 cm and ≤8 cm in diameter and was a safe and feasible procedure for large lesions up to 15 cm . Furthermore, several studies comparing retroperitoneal laparoscopic adrenalectomy (RLA) and LTA have suggested that the RLA outcomes were superior to those of LTA, specifically the shorter surgery duration, reduced blood loss, lower postoperative pain, faster recovery, decreased length of hospital stay, improved cost‐effectiveness, and abolished risk of surgical access site herniation .…”

Діагностично-Лікувальний Алгоритм Комплексного Хірургічного Менеджменту Хворих З новоутвореннями Надниркових Залоз

“…На сьогодні не зібрано достатнього обсягу репрезентативного клінічного матеріалу для формулювання універсальних показань і протипоказань до ендохірургії у цих категорій пацієнтів [7]. Наслідок цього -істотна різноманітність клінічних рекомендацій щодо лікування пацієнтів даної групи [8]. Активно дискутується максимальний розмір пухлини, що підлягає лапароскопічному видаленню.…”

Lateral retroperitoneoscopic adrenalectomy for complicated adrenal tumor larger than 5 centimeters

“…A total of 9 studies 15-24 mentioned the comparison on LA and OA, and two studies 25,26 mentioned different diameter of adrenal tumor in LA. There exists controversy on the advantages of laparoscopy, as shown in the summarized information of related studies listed in Table 4.…”