Is laparoscopic adrenalectomy safe and effective for adrenal masses larger than 7 cm?

• Published in: Surgical endoscopy Vol. 22; no. 2; pp. 516 - 521
• Main Authors: Ramacciato, Giovanni, Mercantini, Paolo, Torre, Marco La, Benedetto, Fabrizio Di, Ercolani, Giorgio, Ravaioli, Matteo, Piccoli, Micaela, Melotti, Gianluigi
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.02.2008; Springer; Springer Nature B.V
• Subjects: Abdomen; Abdominal Surgery; Adolescent; Adrenal Gland Neoplasms - pathology; Adrenal Gland Neoplasms - surgery; Adrenalectomy - adverse effects; Adrenalectomy - methods; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Digestive system. Abdomen; Dissection; Endoscopy; Female; Gastroenterology; Gynecology; Hepatology; Humans; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Laparoscopy - adverse effects; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Proctology; Surgery; Tumors; Veins & arteries; Technical; Endocrinology; Surgical; Adrenalectomy; Endoscopic surgery; Treatment; Adrenal glands; Surgery; Laparoscopy; Endoscopy
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-007-9508-1

Background Laparoscopic adrenalectomy (LA) has become the gold standard treatment for small (less than 6 cm) adrenal masses. However, the role of LA for large-volume (more than 6 cm) masses has not been well defined. Our aim was to evaluate, retrospectively, the outcome of LA for adrenal lesions larger than 7 cm. Patients and methods 18 consecutive laparoscopic adrenalectomies were performed from 1996 to 2005 on patients with adrenal lesions larger than 7 cm. Results The mean tumor size was 8.3 cm (range 7–13 cm), the mean operative time was 137 min, the mean blood loss was 182 mL (range 100–550 mL), the rate of intraoperative complications was 16%, and in three cases we switched from laparoscopic procedure to open surgery. Conclusions LA for adrenal masses larger than 7 cm is a safe and feasible technique, offering successful outcome in terms of intraoperative and postoperative morbidity, hospital stay and cosmesis for patients; it seems to replicate open surgical oncological principles demonstrating similar outcomes as survival rate and recurrence rate, when adrenal cortical carcinoma were treated. The main contraindication for this approach is the evidence, radiologically and intraoperatively, of local infiltration of periadrenal tissue.