Surgical management of large adrenal tumors: impact of different laparoscopic approaches and resection methods on perioperative and long-term outcomes

Background: The indication of retroperitoneal laparoscopic adrenalectomy (RLA) was extended with the retroperitoneal approach and has been wildly accepted and technologically matured. However, the management of large adrenal tumors via this approach still remains controversial. The aim of this study was to perform a comprehensive analysis on the minimally invasive surgical management of larger adrenal tumors. Methods: A total of 78 patients with large adrenal tumors (>5 cm) and 97 patients with smaller adrenal tumors (<5 cm) were enrolled in this study. The patient characteristics were preferentially analyzed. The intra-operative and postoperative indicators were compared between those who underwent RLA and those who underwent transperitoneal laparoscopic adrenalectomy (TLA); the intra-operative and postoperative indicators were also compared between the large tumor group and smaller tumor group of those who underwent RLA. Furthermore, the analyses of partial RLA were focused on the perioperative indicators and follow-up results. Results: RLA was superior to TLA in terms of operation time (98.71 +/- 32.30 min vs. 124.36 +/- 34.62 min, respectively, P = 0.001), hospitalization duration (7.43 +/- 2.82 days vs. 8.91 +/- 3.40 days, respectively, P = 0.04), duration of drain (4.83 +/- 0.37 days vs. 3.94 +/- 2.21 days, respectively, P = 0.02), first oral intake (2.82 +/- 0.71 days vs. 1.90 +/- 0.83 days, respectively, P < 0.001) and time to ambulation (3.89 +/- 1.64 days vs. 2.61 +/- 1.42 days, respectively, P < 0.001). Further analyses of the RLA patients demonstrated that the larger tumor (> 5 cm) group showed superior results for the intraoperative indicators than the smaller tumor (< 5 cm) group (P < 0.05), while the results for the postoperative indicators between the two tumor size groups were similar (P > 0.05). Data confirmed that the partial resection method was superior to the total resection method from the perspective of the hormone supplement (0% vs. 48.15%, P = 0.002). The 2-year recurrence-free rates were 92.60 and 92.86% for the total and partial RLA resection methods, respectively (P = 0.97). The partial RLA resection method had a similar complete remission rate as the total RLA resection method (96.30% vs. 100%, respectively, P = 0.47). Conclusion: Both RLA and TLA seem to provide similar effects for the surgical management of large adrenal tumors. However, partial RLA resection should be considered for the management of benign tumors to reduce the hormone supplement.