title: Laparoscopic adrenalectomy in patients with large adrenal tumors.
abstract: OBJECTIVE
  The maximum size of adrenal tumors that should be removed by laparoscopic adrenalectomy is controversial. We conducted a retrospective comparison of the results of laparoscopic adrenalectomy between patients with adrenal tumors > or =6 cm ('large tumors') and patients with adrenal tumors <6 cm ('small tumors').
  
  
  METHODS
  The participants in the study were 16 patients with large tumors and 111 patients with small tumors. The patients comprised 59 men and 68 women (mean age, 49.0 years; age range, 23-79) with varying diagnoses. Of the 16 patients with large tumors, five had Cushing's syndrome, four had pheochromocytomas, six had a non-functional tumor and one had malignant lymphoma. Adrenal tumors were confirmed by hormonal assays, biochemical tests and computed tomography. Of the 16 large tumors, five tumors were on the right and 11 were on the left.
  
  
  RESULTS
  We found no significant differences in general demographic parameters between patients with large and small tumors. The mean duration of surgery was not significantly different between two groups. (large tumors, 210 min; small tumors,175 min). The mean volume of blood loss was 212 mL for large tumors and 30 mL for small tumors (P < 0.001, significant difference). There was no significant difference in time until walking, duration of hospitalization or number of using analgesics used. The time to first oral intake of group 1 (<6 cm) was significantly shorter than group 2 (> or =6 cm). Tumor size (> or =7.5 cm) was an independent predictor of a longer operation and greater blood loss in large tumors.
  
  
  CONCLUSIONS
  Laparoscopic adrenalectomy for large tumors was safe and minimally invasive.
authors.affiliation: Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan. yu7ki@aol.com
authors.forename: Yukio
authors.initials: Y
authors.lastname: Naya
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Suzuki
authors.forename: Akira
authors.initials: A
authors.lastname: Komiya
authors.forename: Maki
authors.initials: M
authors.lastname: Nagata
authors.forename: Toyofusa
authors.initials: T
authors.lastname: Tobe
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ueda
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Ichikawa
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Igarashi
authors.forename: Kunio
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Haruo
authors.initials: H
authors.lastname: Ito
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D003480:Cushing Syndrome / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008223:Lymphoma / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies