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Applicability of laparoscopic approach to the resection of large adrenal tumours: a retrospective cohort study on 200 patients

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Abstract

Background

Controversies exist in the best surgical approach (open vs. laparoscopy) to large adrenal tumours without peri-operative evidence of primary carcinoma, mainly due to possible capsular disruption of an unsuspected malignancy. In addition, intra-operative blood loss, conversion rate, operative time, and hospital stay may be increased with laparoscopy. The aims of our study were: (1) to compare clinical outcomes of laparoscopic adrenalectomy for large versus small adrenal tumours and (2) to identify risk factors associated with increased operative time and hospital stay in laparoscopic adrenalectomy.

Methods

This is a multicentre retrospective cohort study in a large patient population (N = 200) who underwent laparoscopic adrenalectomy in 2004–2014 at three Italian academic hospitals. Patients were divided into two cohorts according to tumour size: “large” tumours were defined as ≥5 cm (N = 50) and “small” tumours as <5 cm (N = 150). Further analysis adopting a ≥8 cm (N = 15) cut-off size was performed.

Results

The study groups were comparable in age and gender distribution as well as their tumour characteristics. The operative time (p = 0.671), conversion rate (p = 0.488), intra- (p = 0.876) and post-operative (p = 0.639) complications, and hospital stay (p = 0.229) were similar between groups. With a cut-off size ≥5 cm, the early study period (2004–2009), which included operators’ learning curve, was associated with increased risk of longer operative time (HR 0.57; 95 % CI 0.40–0.82), while American Society of Anaesthesiology score ≥3 was associated with prolonged hospital stay (HR 0.67; 95 % CI 0.47–0.97). Tumour size ≥8 cm was associated with prolonged operative time (HR 0.47; 95 % CI 0.24–0.94).

Conclusions

Surgeons skilled in advanced laparoscopy and adrenal surgery can perform laparoscopic adrenalectomy safely in patients with ≥5-cm tumours with no increase in hospital stay, or conversion rate, although operative time may be increased for ≥8-cm tumours. Surgeon’ experience, size ≥8 cm, and patient comorbidities have the largest impact on operative time and length of hospital stay in laparoscopic large adrenal tumour resection.

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Acknowledgments

The authors thank Dr. Simone Sala for his substantial contribution to the revision of the manuscript.

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Authors and Affiliations

  1. Section of Clinica Chirurgica, Department of Morphology, Surgery, and Experimental Medicine, S. Anna University Hospital of Ferrara, University of Ferrara, Ferrara, Italy

    Carlo V. Feo, Mattia Portinari, Silvia Severi & Giorgio Soliani

  2. Department of Surgery, University Hospital of Parma, University of Parma, Parma, Italy

    Umberto Maestroni, Paolo Del Rio & Lorenzo Viani

  3. Section of Clinica Chirurgica, Department of Medical and Biological Science, S. Maria della Misericordia University Hospital of Udine, University of Udine, Udine, Italy

    Riccardo Pravisani, Giovanni Terrosu & Vittorio Bresadola

  4. Section of Endocrinology and Internal Medicine, Department of Medical Sciences, S. Anna University Hospital of Ferrara, University of Ferrara, Ferrara, Italy

    Maria Chiara Zatelli & Maria Rosaria Ambrosio

  5. Division of Endocrinology, Duke University, Durham, NC, USA

    Jenny Tong

  6. Clinica Chirurgica, Arcispedale S. Anna, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro, 8 | 1C2 Room 2 34 03, 44124, Ferrara (Cona), Italy

    Mattia Portinari

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  1. Carlo V. Feo
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Correspondence to Mattia Portinari.

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Disclosures

Drs. Carlo V. Feo, Mattia Portinari, Umberto Maestroni, Paolo Del Rio, Silvia Severi, Lorenzo Viani, Riccardo Pravisani, Giorgio Soliani, Maria Chiara Zatelli, Maria Rosaria Ambrosio, Jenny Tong, Giovanni Terrosu, and Vittorio Bresadola have no conflicts of interest or financial ties to disclose.

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Feo, C.V., Portinari, M., Maestroni, U. et al. Applicability of laparoscopic approach to the resection of large adrenal tumours: a retrospective cohort study on 200 patients. Surg Endosc 30, 3532–3540 (2016). https://doi.org/10.1007/s00464-015-4643-6

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  • DOI: https://doi.org/10.1007/s00464-015-4643-6

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