Laparoscopic adrenalectomy for large-volume (>= 5 cm) adrenal masses

Background and Purpose: Laparoscopic adrenalectomy has emerged as the stand ard of care at many centers for small surgical adrenal masses. However, the role of laparoscopic adrenalectomy in the treatment of large adrenal masse s has not been specifically addressed. Our aim was to evaluate the outcome of laparoscopic v open adrenalectomy for large-volume (greater than or equa l to 5 cm) adrenal masses and to compare laparoscopic adrenalectomy for lar ge- and small-volume (<5 cm) masses. Patients and Methods: Data from 14 patients with large adrenal masses under going laparoscopic adrenalectomy between February 1998 and March 1999 (Grou p I) were retrospectively compared with 14 contemporary large-volume open a drenalectomies between December 1992 and May 1998 (Group II) and 45 small-v olume laparoscopic adrenalectomies between July 1997 and November 1998 (Gro up III). Results: In Group I and Group II, the mean surgical time (205 min v 216 min ) and blood loss (400 mL v 584 mL) were similar. Although the mean adrenal size was also comparable (8 cm v 7.8 cm), the specimen weight of the en blo c adrenal gland and periadrenal fat was greater in Group I (168 g v 106 g), The hospital stay was shorter in Group I (2.4 days v 7.7 days). Minor comp lications occurred in 21.4% of Group I and 50% of Group II patients. On com paring Group I and Group III (laparoscopic <5 cm), Group I had larger speci men weight (168 g v 51.4 g), longer surgical time (205 min v 158 min), grea ter blood loss (400 mL v 113 mt), longer hospital stay (2.4 days v 1.5 days ), a higher complication rate (21.4% v 8.9%), and a higher incidence of ope n surgical conversion (14.3% v 2.2%), Over a mean follow-up of 9.9 months, no local or port-site recurrences have been noted in Group I. Conclusions: Laparoscopic adrenalectomy for large-volume adrenal masses is technically feasible and seems to replicate open surgical oncologic princip les of achieving a wide-margin, en bloc excision of the adrenal gland and p eriadrenal fat, Successful laparoscopic resection is not impacted by the la rge size of the adrenal mass per se but rather by the presence of local inv asion and poorly defined tissue planes that may be encountered in adrenal m alignancy, As such, laparoscopic adrenalectomy for large masses should be a ttempted only by experienced laparoscopic surgeons and then with a low thre shold for open conversion.