title: Adrenal incidentaloma: the influence of a decision-making algorithm on the short-term outcome of laparoscopy.
abstract: BACKGROUND
  At the present time, the precise indications for laparoscopic surgery of adrenal incidentaloma (AI) have yet to be completely clarified. The most controversial issue is the role of laparoscopy in the treatment of potentially malignant and large adrenal masses. Trying to address these questions, we retrospectively examined a group of patients with AIs.
  
  
  METHODS
  Forty-two patients with AIs who were laparoscopically treated since 1995 were enrolled in this study. The patients were divided into two groups: the 27 patients of the immediate surgery (IS) group were operated on immediately, whereas the 15 subjects in the delayed surgery (DS) group needed further evaluations and/or a follow-up period before surgery. Surgical timing for both groups was decided according to a widely accepted decision-making algorithm. Many outcome parameters of laparoscopy (operative time, blood loss, conversion rate, time to liquid and solid food nutrition, drainage removal, resumption of normal bowel habits, and average hospital stay) were analyzed in the two groups. The subjects had AIs of various sizes and different histotypes.
  
  
  RESULTS
  Patients in the DS group had a higher risk for malignancy. The definitive pathology revealed a malignant biology in 26.6% of DS vs. 0% of IS cases. No difference in the outcome parameters of laparoscopy was observed between the two groups or among pathologically different AIs. A significant correlation was found between the operative time and the size of the AI (r=0.836, P<0.001, linear regression test).
  
  
  CONCLUSIONS
  Our study shows that laparoscopy is feasible and safe for AIs, regardless of the preoperative probability of malignancy. The size of the AI was the only determinant for choosing a laparotomy. Further long-term studies are necessary to confirm the laparoscopic efficacy in terms of oncologic safety.
authors.affiliation: Department of General and Vascular Surgery, Careggi Hospital, and Department of Clinical Physiopathology, University of Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Valeri
authors.forename: Carlo
authors.initials: C
authors.lastname: Bergamini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Manca
authors.forename: Massimo
authors.initials: M
authors.lastname: Mannelli
authors.forename: Luigi
authors.initials: L
authors.lastname: Presenti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Peri
authors.forename: Andrea
authors.initials: A
authors.lastname: Borrelli
authors.forename: Pietro
authors.initials: P
authors.lastname: Tonelli
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D000368:Aged; D000465:Algorithms; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D033162:Incidental Findings; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged