[Laparoscopic adrenalectomy of large adrenal lesions]

In recent years, laparoscopic adrenalectomy has become the procedure of choice for small and benign adrenal lesions. With the experience gained in the laparoscopic approach, many surgeons have expanded the range of indications for laparoscopic adrenalectomy and nowadays, this approach is used for large adrenal lesions and in lesions suspicious for malignancy. However, great controversy still exists regarding the oncological safety of this approach and therefore, some surgeons still prefer using the open technique.

To assess the outcome and the oncological safety of Laparoscopic adrenalectomy of large adrenal lesions.

A retrospective analysis was conducted of prospectively collected data of all consecutive patients who underwent laparoscopic adrenatectomy in our department for adrenal lesions of 6 cm or larger during the years 1995-2014.

A total of 50 patients, out of 230 who underwent laparoscopic adrenalectomy in our department, were included in the study. The main indications for surgery were pheochromocytoma, non-functional lesions and Cushing's syndrome. The surgical approach in all cases was the lateral transperitoneal approach. The final histopathological diagnoses in the majority of patients were adenoma and pheochromocytoma. Three patients were diagnosed with adrenocortical carcinoma. During a follow-up period of up to 5-years, no Local or distant recurrences were found.

The laparoscopic approach for removal of adrenal lesions Larger than 6 cm is safe in respect of intra- and peri-operative morbidity as well as oncological safety. The true incidence of malignancy in large adrenal Lesions appears to be lower than that reputed in the Literature thus far. In high-volume centers the laparoscopic approach should be attempted for large adrenal lesions.