Laparoscopic Adrenalectomy for Large Incidentalomas: A Challenge or a Routine?

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 1-36-Adrenal Incidentaloma & Carcinoma
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-16
Diego Vicente*1, Umberto Maestroni2, Paolo Del Rio2, Francesco Ziglioli3, Francesco Dinale3, Davide Campobasso3, Stefania Ferretti3, Alexander Stojadinovic4 and Itzhak Avital5
1Walter Reed National Military Medical Center, 2University Hospital of Parma, 3University Hospital of Parma, Italy, 4Walter Reed National Military Medical Center, Bethesda, MD, 5Bon Secours Cancer Institute, Richmond, VA
Laparoscopic Adrenalectomy for Large Incidentalomas: A Challenge or a Routine?

U. Maestroni1, D. Vicente2, P. Del Rio1, F. Ziglioli1, F. Dinale1, D. Campobasso1, S. Ferretti1, A. Stojadinovic,3,4,  I. Avital5

 1 Department of Surgery -University Hospital of Parma

2 Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD

3 United States Military Cancer Institute, Bethesda, MD

4 Uniformed Services University of the Health Sciences, Bethesda, MD

5 Bon Secours Cancer Institute, Richmond, VA

BACKGROUND: The incidence of adrenal incidentaloma (>1 cm) on radiological imaging is ~5%, while the incidence reported in autopsy series is ~9%. Laparoscopic adrenalectomy is generally recommended for benign masses and pheochromocytoma. For many years laparoscopic adrenalectomy was not indicated for adrenal masses >4 cm, as risk of malignancy exceeds 25% in masses ≥6 cm, and risk of laparoscopic resection increases with tumor size. Our prospective series compares laparoscopic adrenalectomy for both small with large-sized tumors.

METHODS: Outcomes [OR and hospital time; operative blood loss(EBL); 30-day morbidity; re-operation] were compared by tumor size (< vs. ≥ 4cm) for consecutive laparoscopic adrenalectomies performed from 2009 to 2012 (n=77).

RESULTS: Fifty and 27 patients had tumors <4 and ≥ 4cm, respectively. In the ≥ 4cm group, 10 tumors were >6cm in size (largest=14cm). Mean OR time varied by size and laterality: <4cm, right vs. left: 130 vs. 102 minutes; ≥4cm, right vs. left: 135 vs. 116 minutes. Mean EBL for tumors <4 and ≥ 4cm was 30 and 50 ml, respectively. Two(2.6%) cases were converted to open adrenalectomy. Morbidity(5.2%) included pneumothorax (n=2) and post-operative bleeding (n=2). All patients were discharged home on post-operative day 3; there were no re-operations. Pathology by size was: <4cm, adenoma, pheochromocytoma, neuroblastoma, metastasis; ≥4cm, adenoma, pheochromocytoma, myelolipoma, adrenocortical carcinoma, metastasis.

CONCLUSION: Laparoscopic adrenalectomy is safe and effective in incidental tumors ≥4cm. Size of incidentaloma is not a contraindication to the laparoscopic approach. The only absolute contraindication is involvement of surrounding structures that can be readily ascertained by cross-sectional imaging.

Nothing to Disclose: DV, UM, PD, FZ, FD, DC, SF, AS, IA

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