Outcomes analysis in patients undergoing laparoscopic adrenalectomy for hormonally active adrenal tumors

Background. Laparoscopic adrenalectomy (LA) has become the preferred method of removal of most adrenal neoplasms, but few studies have evaluated the f unctional outcomes of this approach. The pur pose of this study was to anal yze our operative results and the clinical and biochemical responses to LA in patients with various hormonally active adrenal tumors. Methods. From 1993 through November 2000, 72 patients with functional adren al tumors underwent attempted LA. Data were obtained retrospectively by rev iew of medical records, during routine follow-up, and by patient questionna ire. Results. Indications for adrenalectomy were pheochromocytoma (n = 35), aldo steronoma (n = 29), cortisol-producing adenoma (n = 5), and adrenocorticotr opic hormone-dependent Cushing's syndrome (n = 3). LA was completed in 70 o f 72 patients, with 2 conversions (3%) to open adrenalectomy. Mean operativ e time for unilateral LA was 176 +/- 60 minutes, and postoperative length o f hospital stay, averaged 3.0 +/- 1.7 days. Complications, most of which we re minor; occurred in 19% of patients; there were no serious complications or perioperative deaths. Two patients were unavailable for follow-up. At a, mean follow-up, interval of 37.6 months after IA (range, 2-90 months), res olution of clinical and biochemical signs of adrenal hyperfunction was acco mplished in 34 of 34 patients with pheochromocytomas, 25 of 26 patients wit h aldosteronomas, 5 of 5 patients with cortisol-producing adenomas, and 3 o f 3 patients with andrenocorticotropic hormone-dependent Cushing's syndrome . Two patients with multiple endocrine neoplasia (MEN) type 2 had contralat eral pheochromocytomas removed 4 and 5 years after the initial surgery. Per sistent hypertension necessitating medication was present in 72% of patient s with aldosteronomas, although 92% of these patients had improved blood pr essure control after LA. Recurrent hypokalemia developed in 1 patient (4%) with a cortical nodule in the contralateral adrenal. No local or distant tu mor recurrences have occurred. Conclusions. LA results in an excellent clinical outcome in patients with v arious functional endocrine tumors. LA is associated with few major complic ations, and clinical and biochemical cure rates are comparable with those o f open adrenalectomy during long-term follow-up.