Laparoscopic trans- and retroperitoneal adrenal surgery for large tumors.
BACKGROUND
Laparoscopic adrenalectomy for tumors larger than 6 cm is currently a matter of controversial discussion because of difficult mobilization from surrounding organs and a possible risk of capsule rupture.


METHODS
Data of consecutive patients undergoing laparoscopic adrenalectomy between 1/1994 and 7/2012 were collected and analysed retrospectively. Intra- and postoperative morbidity in patients with tumors ≤6 cm (group 1, n = 227) were compared to patients with tumors >6 cm, (group 2, n = 52).


RESULTS
Incidence of adrenocortical carcinoma was significantly higher in group 2 patients (6.3% vs. 0.4%, P = 0.039) whereas the incidence of aldosterone-producing adenoma was lower (2% vs. 25%, P = 0.001). Mean duration of surgery was longer (105 min vs. 88 min, P = 0.03) and the estimated blood loss was higher (470 mL vs. 150 mL) in group 2 patients. Intraoperative bleeding rate (5.7% vs. 0.8%, P = 0.041), and the conversion rate were significantly higher (5.7% vs. 1.3%, P = 0.011) in group 2. Also, postoperative complication rate was significantly higher in group 2 (11.5% vs. 3.0%, P = 0.022). However, only two major complications occurred, one in each group.


CONCLUSIONS
Minimally invasive adrenal surgery can be performed by an experienced surgeon even in patients with large tumors (>6 cm) with an increased but still acceptable intra- and postoperative morbidity.
Department of Surgery, University Hospital Regensburg, Regensburg, Germany.
Ayman
A
Agha
Department of Surgery, University Hospital Regensburg, Regensburg, Germany ; Department of Surgery, Marienhospital Gelsenkirchen, Gelsenkirchen, Germany.
Igors
I
Iesalnieks
Department of Surgery, University Hospital Regensburg, Regensburg, Germany.
Matthias
M
Hornung
Department of Radiology, University Hospital Regensburg, Regensburg, Germany.
Wiggermann
W
Phillip
Department of Radiology, University Hospital Regensburg, Regensburg, Germany.
Andreas
A
Schreyer
Department of Radiology, University Hospital Regensburg, Regensburg, Germany.
Michael
M
Jung
Department of Surgery, University Hospital Regensburg, Regensburg, Germany.
Hans J
HJ
Schlitt
Adrenocortical carcinoma; laparoscopic adrenalectomy; postoperative complications