title: Laparoscopic adrenalectomy for large adrenal masses: single team experience.
abstract: BACKGROUND
  Laparoscopic adrenalectomy is today considered the standard treatment for benign small adrenal tumors. An open question is the use of laparoscopy for large adrenal masses because of technical limitations and increased risk of malignancy. In this study we report our experience in laparoscopic adrenalectomy for adrenal masses larger than 6 cm.
  
  
  METHODS
  Between January 2010 and December 2013 we performed 41 laparoscopic adrenalectomy. Fourteen of 41 patients (34,1%) were submitted to laparoscopic adrenalectomy for lesion >6 cm in size. All patients were submitted routinely to radiological and hormonal tests to indentify tumors characteristics.
  
  
  RESULTS
  The patients treated were 9 male and 5 female, the mean age was 55.6 years (range 38-74). The mean tumor size was 8.2 cm (range 6-14 cm) and the lesion were localized on right side in 8 patients and on the left side in 6 patients. The mean operative time was 181 min (range 145-240 min). Mean blood loss was 90 ml. No conversion to open surgery was required.
  
  
  CONCLUSIONS
  Laparoscopic adrenalectomy offers better surgical outcomes than open adrenalectomy. Size criteria are, at the moment, the main subject discussed for the laparoscopic approach to adrenal tumors. In fact, size is an important variable in predicting malignancy. This experience and the results of literature suggest that laparoscopic approach is safe and feasible for adrenal masses larger than 6 cm with a longer operative time. In presence of local invasion or vascular infiltration laparoscopy is contraindicated.
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè 5, 90127 Palermo, Italy. Electronic address: antonino.agrusa@unipa.it.
authors.forename: A
authors.initials: A
authors.lastname: Agrusa
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè 5, 90127 Palermo, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Romano
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè 5, 90127 Palermo, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Frazzetta
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè 5, 90127 Palermo, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Chianetta
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè 5, 90127 Palermo, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Sorce
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè 5, 90127 Palermo, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Di Buono
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè 5, 90127 Palermo, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Gulotta
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018209:Myelolipoma / Q000473:pathology / Q000601:surgery*; D061646:Operative Time; D010673:Pheochromocytoma / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Laparoscopic adrenalectomy; Laparoscopic surgery; Laparoscopy; Large adrenal tumors