Endoscopic treatment of large primary adrenal tumours

Background: Endoscopic adrenalectomy has become the treatment of choice for small benign adrenal tumours but should not be used for malignant lesions. It is debatable whether large and therefore potentially malignant primary adrenal tumours should be removed by minimally invasive techniques. Methods: Three hundred and eighty primary adrenal tumours in 368 patients (142 male and 226 female; mean(s.d.) age 48.9(14.4) years) were excised by laparoscopic or retroperitoneoscopic adrenalectomy. Adrenal neoplasias exceeded 6 cur in diameter (range 6-13 cm) in 33 patients (18 male and 15 female; age 42.6(14.2) years). Results: There were no deaths. Patients with large tumours had an increased conversion rate (P = 0.039), longer operating time (P < 0.001) and greater intraoperative blood loss (P = 0.007) than those with smaller lesions, but a similar overall morbidity rate (P = 0.207). Six malignant tumours were identified (diameter 4-10 cm; four phaeochromocytomas and two adrenocortical carcinomas). Local recurrence developed in two patients and distant metastasis occurred in all six patients with malignant lesions. Conclusion: Endocopic adrenalectomy perfomed by an experienced surgeon should be the treatment of choice for tumours exceeding 6 cm. in diameter.