Laparoscopic adrenalectomy in patients with large adrenal tumors.
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.
Naya
Yukio
Y
Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan. yu7ki@aol.com
Suzuki
Hiroyoshi
H
Komiya
Akira
A
Nagata
Maki
M
Tobe
Toyofusa
T
Ueda
Takeshi
T
Ichikawa
Tomohiko
T
Igarashi
Tatsuo
T
Yamaguchi
Kunio
K
Ito
Haruo
H
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