Is laparoscopic adrenalectomy safe and effective for adrenal masses larger than 7 cm?
BACKGROUND
Laparoscopic adrenalectomy (LA) has become the gold standard treatment for small (less than 6 cm) adrenal masses. However, the role of LA for large-volume (more than 6 cm) masses has not been well defined. Our aim was to evaluate, retrospectively, the outcome of LA for adrenal lesions larger than 7 cm.


METHODS
18 consecutive laparoscopic adrenalectomies were performed from 1996 to 2005 on patients with adrenal lesions larger than 7 cm.


RESULTS
The mean tumor size was 8.3 cm (range 7-13 cm), the mean operative time was 137 min, the mean blood loss was 182 mL (range 100-550 mL), the rate of intraoperative complications was 16%, and in three cases we switched from laparoscopic procedure to open surgery.


CONCLUSIONS
LA for adrenal masses larger than 7 cm is a safe and feasible technique, offering successful outcome in terms of intraoperative and postoperative morbidity, hospital stay and cosmesis for patients; it seems to replicate open surgical oncological principles demonstrating similar outcomes as survival rate and recurrence rate, when adrenal cortical carcinoma were treated. The main contraindication for this approach is the evidence, radiologically and intraoperatively, of local infiltration of periadrenal tissue.
Ramacciato
Giovanni
G
Department of Surgery, University of Rome La Sapienza, II(o) School of Medicine, Azienda Ospedaliera Sant' Andrea Via di Grottarossa 1035, 1039 00189, Rome, Italy. giovanni.ramacciato@uniroma1.it
Mercantini
Paolo
P
La Torre
Marco
M
Di Benedetto
Fabrizio
F
Ercolani
Giorgio
G
Ravaioli
Matteo
M
Piccoli
Micaela
M
Melotti
Gianluigi
G
D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000473:pathology* / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged
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