Comparative Efficacy of Laparoscopic Versus Robotic Adrenalectomy for Adrenal Malignancy

To evaluate whether the technical advantages of robotic-assisted surgery over standard laparoscopy, which are well established for complex renal surgery, lead to variable surgical outcomes between laparoscopic adrenalectomy (LA) and robotic adrenalectomy (RA).

Using the National Cancer Database, we identified patients who underwent LA or RA for nonmetastatic primary adrenal malignancy from 2010 to 2013. Primary outcomes were need for open conversion, surgical margin status, and performance of regional lymphadenectomy. Secondary outcomes were length of stay, readmission, and perioperative mortality. Baseline characteristics and outcomes were compared between approaches using the chi-square, Fisher's exact, and Mann-Whitney U tests.

Two hundred thirty-eight (82%) LA and 51 (18%) RA cases were identified. The LA and RA groups did not show any significant differences in terms of patient age, gender, race, Charlson score, tumor laterality, size (median 4.2-9.0 cm), histology, grade, hospital type, and case volume. The rate of open conversion was 5.9% for RA versus 17.2% for LA (P = .04). There were no significant differences in rates of positive margins, lymphadenectomy, inpatient stay, readmission, or mortality.

RA significantly decreases need for open conversion compared to LA. Although RA improves technical feasibility, the oncological adequacy of minimally invasive resection remains uncertain.