Objective: To evaluate the feasibility and safety of retroperitoneal laparoscopic adrenalectomy for larger adrenal tumor.
Methods: A retrospective cohort study of patients who underwent retroperitoneal laparoscopic adrenalectomy in a single unit from July 2004 to December 2008 was undertaken, in which 53 cases were divided into 2 groups according to size as estimated by group A [n=13; age: 45+/-18 years; size: (7.6+/-1.2) cm, maximum diameter of tumor larger than 6 cm] and group B [n=40; age: (49+/-12) years; size: (4.0+/-0.9) cm, between 3 and 6 cm].
Results: All procedures were performed successfully. In comparison between the 2 groups ,the mean operative time [(127+/-77) min vs (107+/-47) min, P<0.05] and estimated blood loss [(167+/- 223) mL vs (65+/-60) mL,P<0.01] had significant difference. The intraoperative complications and blood transfusion rate in group A were higher than those of group B (23% vs 12.5% and 15% vs 2.5%),no difference was noted in their hospital stay after operation [(7.1+/-1.1) d vs (5.5+/-0.7) d, P>0.05]. Group A was followed up for 25+/-14 months,during which time no local recurrence was noted in 8 cases, 3 cases were missed ,and 2 cases were alive with hydronephrosis. Group B was followed up for 29+/-14 months, during which time 30 cases were free, 9 cases were lost, and 1 case was found with real disfunction. The pathology of most tumors in group A included medullary lipoma(30.8%), pheochromocytoma(23%) and ganglioneuroma(23%), the others included adenoma(32.5%), pheochromocytoma(25%) and ganglioneuroma(17.5%) in group B.
Conclusion: Retroperitoneal laparoscopic adrenalectomy has best value in patients with larger adrenal tumor and it is a minimally invasive and safe procedure for skillful surgeons in the treatment of tumor size larger than 6 cm.