World Journal of Surgery

, Volume 30, Issue 5, pp 893–898 | Cite as

Long-term Outcome following Laparoscopic Adrenalectomy for Large Solid Adrenal Cortex Tumors

  • F. Fausto Palazzo
  • Frederic Sebag
  • Mauricio Sierra
  • Giuseppe Ippolito
  • Philippe Souteyrand
  • Jean-François Henry



Laparoscopic adrenalectomy (LA) is the procedure of choice for small benign adrenal tumors. In the absence of local invasion or metastases, the preoperative diagnosis of an adrenocortical carcinoma (ACC) is difficult, often leaving size as the principal predictor of malignancy. Large tumors are resectable laparoscopically, but the long-term outcome and therefore appropriateness of LA for cortical tumors > 6 cm is not known.


We reviewed the LA experience in our institution since its introduction in June 1994. Patients who underwent LA for solid cortical tumors ≥ 60 mm in diameter without preoperative or intraoperative evidence of malignancy were reviewed. Follow-up data, including clinical examination, biochemical analysis, and repeat scans, were reviewed for evidence of local or systemic recurrent disease.


Between 1994 and 2004 a total of 462 adrenalectomies were performed, 391 of which were done laparoscopically. Among them, 19 were solid cortical tumors ≥ 60 mm in diameter with no overt malignant preoperative or intraoperative characteristics: 9 nonsecreting tumors, 8 Cushing’s syndrome tumors (including 2 virilizing variants), 1 virilizing tumor, and 1 aldosteronoma. The mean age of the patients was 49.9 years (range 22–77 years), and the mean tumor size was 69.0 mm (range 60–80 mm). Histology confirmed a cortical adenoma in eight patients, malignant tumors in three, and indeterminate tumors in eight. The mean follow-up was 34 months (range 4–108 months). Two patients died of systemic recurrent disease (liver metastases) at 10 and 19 months, respectively, following surgery; two other patients died 12 and 21 months, respectively following surgery owing to unrelated cardiovascular and cerebrovascular pathology. One patient underwent surgery for local recurrence 54 months after primary surgery; the remaining 14 patients are well with no clinical or radiologic evidence of recurrent disease.


Laparoscopic adrenalectomy for large solid cortical tumors without pre- or intraoperative evidence of malignancy is not contraindicated, and it is unlikely to have a deleterious effect on long-term outcome. Each case should be considered individually. We provide an algorithm for the approach to adrenocortical tumors ≥ 6 cm.


Laparoscopic Approach Adrenal Tumor Laparoscopic Adrenalectomy Adrenocortical Carcinoma Open Adrenalectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Société Internationale de Chirurgie 2006

Authors and Affiliations

  • F. Fausto Palazzo
    • 1
  • Frederic Sebag
    • 1
  • Mauricio Sierra
    • 1
  • Giuseppe Ippolito
    • 1
  • Philippe Souteyrand
    • 1
  • Jean-François Henry
    • 1
  1. 1.Department of Endocrine SurgeryLa Timone University HospitalMarseilleFrance

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