Navigating Large Adrenal Tumors: Insights from Minimally Invasive Surgery at a Tertiary Referral Center

Large adrenal tumors (LATs) pose challenges in clinical management, with varied approaches and outcomes reported.

To analyze the surgical outcomes of large adrenal tumors and compare the minimally invasive and open approaches.

Retrospective analysis of large adrenal tumors operated at a tertiary care center.

Tumors ⩾6 cm on preoperative imaging were included. Data encompassing demographics, preoperative evaluations, surgical techniques, perioperative outcomes, and histopathological findings were analyzed. Receiver Operating Characteristic (ROC) analysis was used to determine a tumor size threshold predictive of malignancy. Statistical analysis was performed using SPSS v26.0.

The mean age was 46.9 years, with a female predominance (70%). Incidental findings accounted for 52.2% of cases, while pain was the most common presenting symptom. Functioning tumors comprised 52.17% of cases, with no significant association between functioning status and malignancy risk. ROC analysis identified 7.4 cm as a malignancy-predictive cutoff (AUC = 0.77, p = 0.027). Laparoscopic and open approaches demonstrated comparable outcomes, with laparoscopy associated with lesser blood loss (90 vs 232 ml, p = 0.001) and significantly fewer major complications (0% vs 17.3%, p = 0.022).

Our study underscores the importance of vigilant evaluation and multidisciplinary management in LATs. Tumor size emerged as a critical determinant of malignancy, with laparoscopic surgery offering safe and comparable outcomes to open surgery in selected cases. Prospective studies are needed to validate these findings.