Laparoscopic adrenalectomy for pheochromocytoma-does size matter? A single surgeon comparative study

BACKGROUND Surgical difficulty in laparoscopic adrenalectomy for pheochromocytoma increases with tumor size. We compared single surgeon outcomes of laparoscopic adrenalectomy for pheochromocytomas in patients with tumors smaller or greater than 4 cm to assess safety of the procedure. METHODS A retrospective review was performed of laparoscopic adrenalectomies for pheochromocytoma by a single surgeon over a 3-year period. All patients underwent lateral transperitoneal surgery. Operative and outcome data was retrieved and compared for tumors >4 cm versus smaller tumors. RESULTS We performed 28 laparoscopic adrenalectomies on 24 patients including four simultaneous bilateral surgeries. Fifteen tumors were greater than 4 cm in size (mean 6.3 cm) while 13 were smaller (mean 2.9 cm). Both groups had similar operating time (138 vs. 116 min; P=0.2) and blood loss (181 vs. 143 mL; P=0.41). The small tumor group had four Clavien-Dindo grade 1 and one grade 3a complication while the large tumor group had three grade 1 complications. There were no conversions to open surgery. Eighteen patients (75%) did not require any anti-hypertensive medications post-operatively. CONCLUSIONS Tumor size does not impact outcomes of laparoscopic adrenalectomy for pheochromocytomas. Larger tumors are associated with similar operative time, blood loss and complications as smaller ones.