Are Adrenal Lesions of 6 cm or More in Diameter a Contraindication to Laparoscopic Adrenalectomy? A Case–Control Study

  • Andrea BallaEmail author
  • Livia Palmieri
  • Francesca Meoli
  • Diletta Corallino
  • Monica Ortenzi
  • Pietro Ursi
  • Mario Guerrieri
  • Silvia Quaresima
  • Alessandro M. Paganini
Original Scientific Report



The aim of this case–control study is to compare the surgical outcomes of laparoscopic adrenalectomy (LA) for lesions measuring ≥6 cm versus ≤5.9 cm in diameter.


Eighty-one patients with adrenal gland lesions ≥6 cm in diameter (intervention group) were identified. Patients were matched to 81 patients with adrenal gland ≤5.9 cm in diameter (control group) based on disease (Conn–Cushing syndrome, pheochromocytoma, primary or secondary adrenal cancer or other disease), lesion side (right, left), surgical technique (anterior transperitoneal approach for right and left LA or anterior transperitoneal submesocolic for left LA) and body mass index class (18–24.9, 25–29.9, 30–34.9, 35–39.9, ≥40 kg/m2). Surgical outcomes were compared between the intervention and control groups.


Mean operative time was statistically significantly longer in the interventional arm (101.4 ± 52.4 vs. and 85 ± 31.6 min, p = 0.0174). Eight conversions were observed in the intervention group (9.8%) compared to four in the control group (4.9%) (p = 0.3690). Five (6.1%) and three (3.7%) postoperative complications were observed in the intervention and control groups, respectively (p = 0.7196). Mean postoperative hospital stay was 4.6 ± 2.4 and 4.1 ± 2.3 days in the intervention and control groups, respectively (p = 0.1957).


Operative time was statistically significantly longer in adrenal gland lesions ≥6 cm in diameter (vs. ≤5.9 cm). Conversion and complication rates were also higher, but the difference was not statistically significant. Based on the present data, adrenal gland lesions ≥6 cm in diameter are not an absolute contraindication to the laparoscopic approach.



There are no grant support or financial relationships for the present study.

Compliance with ethical standards

Conflict of interest

Dr. Andrea Balla, Dr. Livia Palmieri, Dr. Francesca Meoli, Dr. Diletta Corallino, Dr. Monica Ortenzi, Dr. Pietro Ursi, Prof. Mario Guerrieri, Dr. Silvia Quaresima and Prof. Alessandro M. Paganini have no conflicts of interest or financial ties to disclose.

Human and animal rights

The present study was approved by our Institutional review board.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  1. 1.Department of General Surgery and Surgical Specialties “Paride Stefanini”Sapienza University of RomeRomeItaly
  2. 2.Department of General SurgeryUniversità Politecnica delle MarcheAnconaItaly

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