title: Adrenal incidentalomas: should we operate on small tumors in the era of laparoscopy?
abstract: Tumor size smaller than 4 cm as an indication for surgical treatment of incidentaloma is still a subject of discussion. Our aim was the estimation of the incidence of malignancy and analysis of treatment outcomes in patients with incidentaloma smaller than 4 cm in comparison to bigger lesions. 132 patients who underwent laparoscopic adrenalectomy for nonsecreting tumors were divided into two groups: group 1 (55 pts., size < = 40 mm) and group 2 (77 pts., size > 40 mm). Operation parameters and histopathological results were analyzed. No differences in group characteristics, mean operation time, and estimated blood loss were noted. Complications in groups 1 and 2 occurred in 3.6% and 5.2% of patients, respectively (P = 0.67). Malignancy in groups 1 and 2 was present in 1 and 6 patients, respectively (P = 0.13). Potentially malignant lesions were identified in 4 patients in group 1 and 4 patients in group 2 (P = 0.39). The results do not allow for straightforward recommendations for surgical treatment of smaller adrenal tumors. The safety of laparoscopy and minimal, but impossible to omit, risk of malignancy support decisions for surgery. On the other hand, the risk of malignancy in smaller adrenal tumors is lower than surgical complications, which provides an important argument against surgery.
authors.affiliation: Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501 Kraków, Poland.
authors.forename: Michał
authors.identifier: 0000-0001-9073-2667
authors.initials: M
authors.lastname: Pędziwiatr
authors.affiliation: Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501 Kraków, Poland.
authors.forename: Michał
authors.identifier: 0000-0002-8588-4989
authors.initials: M
authors.lastname: Natkaniec
authors.affiliation: Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501 Kraków, Poland.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Kisialeuski
authors.affiliation: Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501 Kraków, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Major
authors.affiliation: Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501 Kraków, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Matłok
authors.affiliation: Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501 Kraków, Poland.
authors.forename: Damian
authors.initials: D
authors.lastname: Kołodziej
authors.affiliation: Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501 Kraków, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Zub-Pokrowiecka
authors.affiliation: Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501 Kraków, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Budzyński
authors.affiliation: Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501 Kraków, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budzyński