The surgical approach to adrenal tumors

INTRODUCTION: Adrenalectomy is the treatment of choice for active, hormone producing, adrenal tumors and for most adrenal malignancies. However, this operation is still perceived by many as a risky, complex procedure resulting in a high rate of complications and even death. GOAL: To describe the experience of a single surgical department with the resection of adrenal tumors. PATIENTS: During a 10 year period 96 patients with a variety of adrenal tumors underwent operations. Forty nine were preoperatively diagnosed with a hormone producing tumor and 38 were operated on for a suspected malignancy. Symptoms and signs were in accordance with tumor type. Twenty five of the patients were asymptomatic and tumors were diagnosed incidentally. RESULTS: Overall, 97 adrenalectomies were performed--48 of the right adrenal, 47 left and one bilateral. Sixty three patients were operated on via an open approach and 33 laparoscopically of which one was converted to an open procedure (3% conversion rate). The average length of the operation was 140 minutes for the open procedure and 120 minutes for the laparoscopy. Complications occurred in 23% of patients, with a higher rate for the open approach (30% vs. 12%). The average length of hospital stay was 6.8 days for the open procedure and 3.4 for the laparoscopic adrenalectomy. CONCLUSIONS: Adrenalectomy is a safe and efficient operation. The laparoscopic technique is an important addition to the treatment arsenal of adrenal tumors and is becoming the gold standard for small, benign tumors.