Feasibility and Safety of Laparoscopic Transperitoneal Adrenalectomy in Large Adrenal Tumor From 20 Years Single-center Experiences- A Retrospective Cohort Study

Abstract Background: The role of laparoscopic adrenalectomy (LA) in a large adrenal tumor is controversial due to the risk of malignancy and technical difficulty. In this study, we compared the perioperative outcomes and complications of LA on large (≥ 6 cm) and (< 6 cm) adrenal tumors.Methods: We retrospectively reviewed all clinical data of patients who underwent unilateral LA in our institution between April 2000 and June 2019. Patients were classified by tumor size into 2 groups. Patients in group 1 had tumor size < 6 cm (n=408) and patient in group 2 had tumor size ≥ 6 cm (n=48). Demographic data, perioperative outcomes, complications, and pathologic reports were compared between groups.Results: Patients in group 2 were significant older (p=0.04), thinner (p=0.001) and had lower incident of hypertension (p=0.001), with a significantly higher median operative time (75 vs 120 min), estimated blood loss (20 vs 100 ml), transfusion rate (0 vs 20.8%), conversion rate (0.25 vs 14.6%) and length of stays (6 vs 9 days) than in group 2 (all p<0.001). Group 2 patients also had significantly higher frequency of intraoperative complication (4.7 vs 31.3%; adjust Odds Ratio [OR] =7.73 (95% CI 3.35-17.84), p-value < 0.001) and postoperative complication (5.4 vs 31.3%; adjust OR=6.06, 95% CI 2.84-13.73, p-value < 0.001). Only eight (1.8%) major complications occurred in this study. The most common pathology in group 2 patient was pheochromocytoma and metastasis. Conclusions: Laparoscopic transperitoneal adrenalectomy in large adrenal tumor ≥ 6 cm is feasible but associated with significantly worse intraoperative complications, postoperative complications and recovery. However, most of the complications were minor and could be managed conservatively. Careful patient selection with the expertise surgeon in adrenal surgery are the key factors for successful laparoscopic surgery in a large adrenal tumor. Trial registration: This study was retrospectively registered in the Thai Clinical Trials Registry on 02/03/2020. The registration number was TCTR20200312004.