title: Is larger tumor size a contraindication to retroperitoneal laparoscopic adrenalectomy?
abstract: OBJECTIVE
  To evaluate the surgical feasibility of retroperitoneal laparoscopic adrenalectomy for tumors exceeding 5 cm.
  
  
  METHODS
  A retrospective review was carried out on all adrenalectomies performed between 2002 and 2011. All surgical procedures were performed or supervised by one of two experienced laparoscopic surgeons. A total of 133 patients who underwent retroperitoneal laparoscopic adrenalectomy were divided according to tumor size: group I (n = 57) had tumors <5 cm and group II (n = 76) had tumors ≥5 cm. The operative outcomes included surgical time, change in hemoglobin level, estimated blood loss, necessity for blood transfusion, time to ambulation, hospitalization duration, postoperative complications according to the Clavien-Dindo classification, and the rate of conversion to open surgery.
  
  
  RESULTS
  The estimated blood loss (271.75 ± 232.98 mL vs. 367.24 ± 275.11 mL; p = 0.037), time to ambulation (1.60 ± 0.49 days vs. 1.89 ± 0.31 days; p = 0.001), and postoperative hospitalization (7.88 ± 3.08 days vs. 9.264 ± 3.10 days; p = 0.012) were significantly higher in group II. The operation time and hemoglobin level change were not statistically different between groups. Blood transfusions were performed in 3 patients from group I and 6 patients from group II (5.3 vs. 7.9 %; p = 0.449). No patients experienced conversion to open surgery.
  
  
  CONCLUSIONS
  Retroperitoneal laparoscopic adrenalectomy can be used in patients with tumors larger than 5 cm.
authors.affiliation: Department of Urology, Chonnam National University, 42, Jebongno, Donggu, Gwangju, 501-757, Republic of Korea.
authors.forename: Insang
authors.initials: I
authors.lastname: Hwang
authors.forename: Seung-Il
authors.initials: SI
authors.lastname: Jung
authors.forename: Seong Hyeon
authors.initials: SH
authors.lastname: Yu
authors.forename: Eu Chang
authors.initials: EC
authors.lastname: Hwang
authors.forename: Ho Song
authors.initials: HS
authors.lastname: Yu
authors.forename: Sun-Ouck
authors.initials: SO
authors.lastname: Kim
authors.forename: Taek Won
authors.initials: TW
authors.lastname: Kang
authors.forename: Dong Deuk
authors.initials: DD
authors.lastname: Kwon
authors.forename: Kwangsung
authors.initials: K
authors.lastname: Park
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods; D000075202:Contraindications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012187:Retroperitoneal Space / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index
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