Laparoscopic Adrenalectomy for Adrenal Tumor Larger than 5 cm

ABSTRACT

OBJECTIVE: The adrenal gland is small and located in difficult area to approach, anatomically. Laparoscopic adrenalectomy (LA) is considered as a best approach for the treatment for adrenal tumors. However, its role in removal of larger tumor (>5 cm) is still questioned due to concerns of complexity of procedure. We evaluate technical feasibility and analyze the outcome of LA for large adrenal masses. METHODS: The data of 36 patients who underwent LA for adrenal mass were analyzed for this study. Group 1 (n=27, mean diameter=2.43 cm) consisted of tumors smaller than 5 cm and group 2 (n=9, mean diameter=5.64 cm) consisted of larger than 5 cm. The length of operation time, estimated blood loss, analgesics usage, length of hospital stay, histopathology, tumor size, and perioperative complications were compared. RESULTS: All operation was completed safely and no one required conversion to open surgery. Group 1 (146.48 minutes) had a significantly shorter mean operative time compared to group 2 (181.00 minutes) (P<0.05). There was no significant difference in the postoperative hospital stay, time to remove the drainage, estimated blood loss, and the number of analgesics usage. No major complication was occurred during and after operation but one case of pulmonary congestion was occurred in group 2. Histopathologic findings were 20 cortical adenomas (55.6%), 3 cystic lesions (8.3%), and 3 malignant lesions (8.3%). CONCLUSION: LA is safe and feasible for large adrenal tumors without local invasion. The size of an adrenal tumor should not be the primary factor in determining whether a LA should be performed.