title: Laparoscopic resection of large adrenal tumors.
abstract: BACKGROUND
  Laparoscopic adrenalectomy has rapidly replaced open adrenalectomy as the procedure of choice for benign adrenal tumors. It still remains to be clarified whether the laparoscopic resection of large (≥ 8 cm) or potentially malignant tumors is appropriate or not due to technical difficulties and concern about local recurrence. The aim of this study was to evaluate the short- and long-term outcome of 174 consecutive laparoscopic and open adrenalectomies performed in our surgical unit.
  
  
  METHODS
  Our data come from a retrospective analysis of 174 consecutive adrenalectomies performed on 166 patients from May 1997 to December 2008. Fifteen patients with tumors ≥ 8 cm underwent laparoscopic adrenalectomy. Sixty-five patients were men and 101 were women, aged 16 years to 80 years. Nine patients underwent either synchronous or metachronous bilateral adrenalectomy. Tumor size ranged from 3.2 cm to 27 cm. The largest laparoscopically excised tumors were a ganglioneuroma with a mean diameter of 13 cm and a myelolipoma of 14 cm.
  
  
  RESULTS
  In 135 patients, a laparoscopic procedure was completed successfully, whereas in 14 patients the laparoscopic procedure was converted to open. Seventeen patients were treated with an open approach from the start. There were no conversions in the group of patients with tumors > 8 cm. Operative time for laparoscopic adrenalectomies ranged from 65 minutes to 240 minutes. In the large adrenal tumor group, operative time for laparoscopic resection ranged from 150 minutes to 240 minutes. The postoperative hospital stay for laparoscopic adrenalectomy ranged from 1 day to 2 days (mean, 1.5) and from 5 days to 20 days for patients undergoing the open or converted procedure. The mean postoperative stay was 2 days for the group with large tumors resected by laparoscopy.
  
  
  CONCLUSIONS
  Laparoscopic resection of large (≥ 8 cm) adrenal tumors is feasible and safe. Short- and long-term results did not differ in the 2 groups.
authors.affiliation: Third Department of Surgery, Athens General Hospital «G. Gennimatas», Greece, MD, 10 Oyrani Street, Athens 15237, Greece. gnzografos@yahoo.com
authors.forename: George N
authors.initials: GN
authors.lastname: Zografos
authors.forename: Athanasios
authors.initials: A
authors.lastname: Farfaras
authors.forename: George
authors.initials: G
authors.lastname: Vasiliadis
authors.forename: Theodora
authors.initials: T
authors.lastname: Pappa
authors.forename: Chrysanthi
authors.initials: C
authors.lastname: Aggeli
authors.forename: Evangeline
authors.initials: E
authors.lastname: Vassilatou
authors.forename: Evagelina
authors.initials: E
authors.lastname: Vasilatou
authors.forename: Gregory
authors.initials: G
authors.lastname: Kaltsas
authors.forename: George
authors.initials: G
authors.lastname: Piaditis
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult