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Laparoscopic approach of pediatric adrenal tumors

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Abstract

Purpose

To analyze the role of laparoscopic surgery for the management of pediatric adrenal tumors (AT).

Methods

Retrospective analysis of children diagnosed with AT, operated laparoscopically during 2003–2020. The strategy differed according to tumor extension. AT < 6 cm were resected. Locally advanced tumors (L2) or > 6 cm were biopsied.

Results

N = 28. Complete tumor resection (R0) in 20 (71%), tumor biopsy in 8 (R2). Age (median): 28.8 months (2 months–18 years). 14/28 left-sided, 2 bilateral. Median operating time: 78 min (45–180). Mean tumor size (for resections): 4 cm (2.5–6). Tumor pathology: neuroblastoma (n = 17), Ganglioneuroma (n = 7), Adrenocortical carcinoma (n = 1), Osteosarcoma metastasis (n = 1), Pheochromocytoma (n = 1), Venous malformation (n = 1). Mean hospital stay: 2.5 days (1–3). Mean follow up: 65.5 months (24–192). Overall survival and event-free survival were 86 and 75%, respectively (5 years event-free survival for neuroblastoma: 33% [intermediate risk], 16.6% [high risk]. No surgery-related mortality.

Conclusion

Laparoscopic surgery for adrenal tumors is safe. Laparoscopic biopsy is useful for unresectable tumors when a percutaneous approach is not possible. With the proposed selection criteria, the laparoscopic approach should be the first option for resection of small and localized AT in pediatrics.

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Acknowledgements

The authors would like to thank Dr. Chan Hon Chui for his suggestions to improve the manuscript; Dr. Néstor Forenza for his contribution to the data collection; Dr. Roberto Vagni and Dr. Gastón Elmo for permitting the inclusion of their patients.

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  1. Pediatric Surgery Division, Hospital Italiano de Buenos Aires, Tte. Gral. J. D. Perón, 4190, Buenos Aires, Argentina

    Raquel Oesterreich, Maria Florencia Varela, Juan Moldes & Pablo Lobos

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  1. Raquel Oesterreich
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Correspondence to Raquel Oesterreich.

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Oesterreich, R., Varela, M.F., Moldes, J. et al. Laparoscopic approach of pediatric adrenal tumors. Pediatr Surg Int 38, 1435–1444 (2022). https://doi.org/10.1007/s00383-022-05188-x

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