Laparoscopic adrenalectomy for large solid cortical tumours--is it appropriate?

Laparoscopic adrenalectomy, the procedure of choice for small benign adrenal tumours, is also used for large tumours. Our study aims to assess the outcome of large adrenal tumours laparoscopically resected.

All patients with laparoscopic adrenalectomy performed in between 2002 and 2009, without preoperative or intraoperative malignant characteristics, were reviewed. Clinical, biochemical and CT follow-up data were reviewed for evidence of recurrent disease.

Fifty patients underwent laparoscopic adrenalectomies in our unit, 18 of them having solid cortical tumours > or = 7 cm without preoperative or intraoperative malignant features: 6 Cushing's syndrome tumours, 8 non-secreting tumours, 4 aldosteronomas. The mean age of the patients was 46.89 years (range 22-64 years), and the mean tumour size 7.57 cm (range 7-9.1 cm). Histology identified 10 cortical adenomas, 4 malignant tumours, and 4 indeterminate tumours. The mean - follow-up was 28.94 months (range 4-58 months). Three patients died of systemic recurrent disease (liver and lung metastases) at 12, 19 and 21 month, respectively, after operation. One patient underwent a left hepatectomy for liver metastases, 33 months postoperatively. Fourteen patients have no evidence of recurrence.

Adrenal tumours > or = 7 cm without pre- or intraoperative evidence of malignancy are resectable laparoscopically. This approach is unlikely to worsen the long-term outcome. The mortality is related to the malignancy.