title: Endoscopic adrenalectomy in large adrenal tumors.
abstract: BACKGROUND
  The purpose of this study was to evaluate the frequency of malignancy, oncologic outcome and perioperative morbidity between small (≤60 mm) and large (>60 mm) adrenal tumors treated by endoscopic adrenalectomy (EA).
  
  
  METHODS
  EA was performed in 289 consecutive patients with a mean follow-up of 87.7 ± 45.1 months. Patients were divided in those with tumor size ≤60 mm (group 1; n = 252) and >60 mm (group 2; n = 37). Data on patient's age, gender, hormone function, tumor side, operation time, postoperative complications, conversion to open approach, and rate of malignancy were analyzed. Furthermore, disease-free survival in malignant tumors was estimated and compared between both groups.
  
  
  RESULTS
  Patient age (P = .43), gender (P = .09), tumor side (P = .17), and operative time (P = .33) showed no difference in both groups. Functioning tumors were observed in 85% of patients in group 1 compared with 46% in group 2 (P = .0001). Seven (2.8%) patients in group 1 and 7 (18.9%) in group 2 had malignant tumors (P = .0001). Neither rate of conversion (P = .71) and postoperative complication (P = .27) nor recurrence of malignancy (P = .48) differed between both groups. Estimated disease-free survival after 5 years in malignant lesions was 87.5 ± 11.7% for group 1 and 62.5 ± 21.3% for group 2 (P = .49).
  
  
  CONCLUSIONS
  EA is a safe and feasible procedure in the majority of large adrenal tumors. Tumor size does not affect the outcome of surgery. In case of malignancy, it does not increase the rate of local recurrence. In experienced hands, tumor size should not influence the decision of surgical access (endoscopic versus open).
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria. reza.asari@meduniwien.ac.at
authors.forename: Reza
authors.initials: R
authors.lastname: Asari
authors.forename: Oskar
authors.initials: O
authors.lastname: Koperek
authors.forename: Bruno
authors.initials: B
authors.lastname: Niederle
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D015331:Cohort Studies; D018572:Disease-Free Survival; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009929:Organ Size; D010673:Pheochromocytoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome