The change in the principle of performing laparoscopic adrenalectomy from small to large masses

BackgroundLaparoscopic adrenalectomy has become the gold standard in most patients with adrenal tumors. It is unclear; however, at what size an adrenal neoplasm should be resected by means of an open or a laparoscopic approach. The aim of the present study was to compare the outcomes of laparoscopic adrenalectomy for large tumors with smaller tumors.MethodsA prospective study of patients who underwent adrenalectomy during the period 2006–2009 was undertaken. The patients were divided into 2 groups according to the tumor size. Group 1 (n = 29) consisted of patients presenting tumors smaller than 5 cm in diameter; group 2 (n = 31) consisted of patients with tumors larger than 5 cm in diameter.ResultsTwo of the 29 tumors in group 1 (6.8%) were malignant at final histology. However, 11 of the 31 tumors in group 2 (35.4%) were malignant. There were no significant differences between operating time and complications of groups 1 and 2. The intra-operative blood loss was significantly lower in group 1 than in group 2.ConclusionLaparoscopic adrenalectomy is a reasonable procedure for selected large adrenal tumors when a complete resection is technically feasible and there is no evidence of local invasion.