Indications for laparoscopic adrenalectomy as a determinant of the perioperative and postoperative course: a retrospective, single-centre cohort study

Introduction: Laparoscopic adrenalectomy (LA) is a widely used method for the surgical management of adrenal tumours.Aim of the research: To compare the perioperative and postoperative course in patients with adrenal lesions based on indications for LA.Material and methods: We conducted a retrospective, single-centre data analysis of patients undergoing LA between January 2015 and December 2021. The patients were divided into 4 cohorts, depending on endocrine and oncological indications: (1) hormonally active tumours, (2) non-functioning tumours measuring < 40 mm with suspected radiologic features, (3) non-functioning tumours measuring >= 40 mm, and (4) metastases. We established our outcomes on clinical characteristics (age, sex, BMI, Charlson Comorbidity Index (CCI), ASA score, smoking history), perioperative data (side, operation time, blood loss, intraoperative complications, conversion to open surgery, time of drainage, and duration of hospital stay), and postoperative data (histopathological report, 30-day complication rate).Results: A total of 140 patients were included in the study. Comparative analysis of the groups showed differences in ASA score, smoking history, and CCI. The mean operating time was 112 min, and it was significantly longer in the group of patients with adrenal metastases (149 min, p = 0.002). Intraoperative complications were observed in 5 (3.6%) patients, conversion to open surgery was performed 3 times (2.1%). No life-threatening complications were observed in the postoperative period.Conclusions: LA is a safe method of surgical treatment of adrenal tumours. Removal of adrenal metastases is an advanced laparoscopic procedure that requires an experienced surgeon. The course of treatment depends on the qualification and preparation of patients for the procedure by a multidisciplinary team.