Laparoscopic management of adrenal tumors: a four-year experience in a single center

AIM: Today laparoscopy is considered the first choice treatment of many adrenal tumors, although its use is still controversial for large adrenal masses and incidentally found adrenal cortical carcinoma. METHODS: From January 2009 to February 2014 we performed 42 lateral transperitoneal laparoscopic adrenalectomies. The indications for surgery were non-functioning adenoma larger than 4 cm or rapid growth and hormone-secreting tumor. The diagnosis was confirmed in all cases with computed tomography and magnetic resonance imaging and also metaiodobenzylguanidine scintigraphy if pheochromocytoma was suspected. In all cases we realized a complete preoperative hormonal study. We describe and analyzed retrospectively: age, side, indication for surgery, tumor size, length of hospital stay, complication and conversion rate. RESULTS: Twenty-two patients with functional tumors and 20 with non functional tumor were subjected to laparoscopic adrenalectomy. There was no conversion to open surgery. Mean operative time was 120 min and estimated blood loss was 80 mL (range 50-350). There was no mortality or major complications. The average length of hospital stay was 3.5 day. During pheocromocitoma removal hypertension occurred in 2 cases. Patient with aldosteroma became normotensive and no required postoperative antihypertensive therapy. CONCLUSION: Laparoscopic adrenalectomy is a standard safe procedure for adrenal surgery. The risk of encountering incidental adrenal cortical cancer increases for large lesions and additional attention is required in these cases to observe oncologic surgical principles. Pre-operative work –up has a primary role in adrenal surgery. An accurate management of adrenal tumors requires an agreement among radiologist, endocrinologist, oncologist and surgeon. Previus abdominal surgery does not constituite a contraindication to laparoscopic transperitoneal adrenalectomy.