Does size still matter? - Feasibility of posterior retroperitoneoscopic adrenalectomy for tumors >6cm

Retroperitoneoscopic adrenalectomy (RPA) has proven to be safe and feasible with favorable postoperative courses. The role of RPA for tumor sizes larger than 6 cm is still controversial. The aim of the study was to evaluate the postoperative outcome for removal of larger adrenal tumors via the retroperitoneoscopic route.

In this retrospective study, from 105 conducted RPA procedures, thirteen patients with adrenal tumor sizes larger than 6 cm received RPA in our hospital between January 2017 and December 2020. Clinicopathological factors, length of hospital stay, operative time and postoperative outcomes were included in this analysis.

From this patient cohort, six (46.15%) were female and seven (53.85%) were male with a mean age of 53.85 ± 7.89 years and a mean BMI of 28.64 ± 3.61 kg/m2, Cushing's syndrome being the most common diagnosis (53.85%). Mean lesion size was 73.31 ± 10.39 mm, tumor size varied from 60 mm up to 92 mm. Two patients (15.38%) required conversion to open laparotomy due to uncontrollable bleeding or an unclear view on the basis of adhesions. Postoperative complications were noted for one patient (7.69%), who suffered from a small superficial wound infection. Neither capsule ruptures nor mortality were documented. The median hospital stay was 3 days.

A re-evaluation of the arbitrarily placed cut-off should be discussed, since even with a slightly higher but nevertheless acceptable risk of conversion rate, RPA offers many advantages.