Laparoscopic adrenalectomy for large adrenal masses: Is it really more complicated?

Laparoscopic treatment of large adrenal tumors is still questionable due to concern over the risk of malignancy as well as the technical difficulties. No exact dimensional cut-off has been described for laparoscopic adrenalectomy (LA). In this study, we reviewed our experience with LA for masses ≥ 8 cm and tried to determine the limitations of this surgery in this group of patients. Sixteen patients with adrenal mass ≥ 8 cm (Group 1) and 19 patients with adrenal mass < 8 cm (Group 2) treated with transabdominal LA were included in this study. We analyzed operative time, intraoperative and postoperative complications and length of postoperative hospital stay with respect to tumor size and clinopathologic features. Mean maximum tumor diameters were 91.7 mm (range, 80-150 mm) and 52.4 mm (range, 35-73 mm) in Group 1 and Group 2, respectively. Operation time and blood loss were higher in Group 1 compared to Group 2, but these differences did not reach significant levels (p>0.05). Conversion to an open procedure required in two patients, one from each group, because of the firm attachments of adrenal mass to the surrounding tissue. In conclusion, our study demonstrated that LA is a safe and feasible procedure for large lesions even up to 15 cm. The risk of finding incidental adrenal cortical cancer was significantly increased for large lesions in our series as in the literature; therefore, it is important to follow the strict oncological principles in these cases.