title: Endoscopic treatment of large primary adrenal tumours.
abstract: BACKGROUND
  Endoscopic adrenalectomy has become the treatment of choice for small benign adrenal tumours but should not be used for malignant lesions. It is debatable whether large and therefore potentially malignant primary adrenal tumours should be removed by minimally invasive techniques.
  
  
  METHODS
  Three hundred and eighty primary adrenal tumours in 368 patients (142 male and 226 female; mean(s.d.) age 48.9(14.4) years) were excised by laparoscopic or retroperitoneoscopic adrenalectomy. Adrenal neoplasias exceeded 6 cm in diameter (range 6-13 cm) in 33 patients (18 male and 15 female; age 42.6(14.2) years).
  
  
  RESULTS
  There were no deaths. Patients with large tumours had an increased conversion rate (P = 0.039), longer operating time (P < 0.001) and greater intraoperative blood loss (P = 0.007) than those with smaller lesions, but a similar overall morbidity rate (P = 0.207). Six malignant tumours were identified (diameter 4-10 cm; four phaeochromocytomas and two adrenocortical carcinomas). Local recurrence developed in two patients and distant metastasis occurred in all six patients with malignant lesions.
  
  
  CONCLUSIONS
  Endocopic adrenalectomy perfomed by an experienced surgeon should be the treatment of choice for tumours exceeding 6 cm in diameter.
authors.affiliation: Department of Surgery and Centre of Minimally Invasive Surgery, Kliniken Essen-Mitte, Essen, Germany. mkwalz@kliniken-essen-mitte.de <mkwalz@kliniken-essen-mitte.de>
authors.forename: M K
authors.initials: MK
authors.lastname: Walz
authors.forename: S
authors.initials: S
authors.lastname: Petersenn
authors.forename: J A
authors.initials: JA
authors.lastname: Koch
authors.forename: K
authors.initials: K
authors.lastname: Mann
authors.forename: H P H
authors.initials: HP
authors.lastname: Neumann
authors.forename: K W
authors.initials: KW
authors.lastname: Schmid
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D018268:Adrenocortical Carcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D002648:Child; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D010673:Pheochromocytoma / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D018709:Statistics, Nonparametric