Adrenalectomy For Adrenal Tumors: Auditing Two-Decades Experience Of A Single Institution In A Developing Country.

Abstract

BACKGROUND: With widespread use of high-resolution imaging modalities unanticipated adrenal masses are frequently encountered these days.

OBJECTIVE: To study the clinical spectrum of adrenal tumors, and to have an audit of all adrenalectomies performed at our center; reviewing our experience with laparoscopic adrenalectomy (LA) vis-à-vis open adrenalectomy (OA).

STUDY DESIGN: Retrospective review of prospectively collected data.

METHODS: Records of all patients who underwent adrenalectomy in last two-decades at our center, a tertiary care hospital in Northern India, were reviewed for patient factors, surgical approach, peri-operative complications and outcome.

RESULTS: Of 125 patients who had undergone adrenalectomy, only 97 subjects had histopathology available, including pheochromocytoma (n=40), adrenocortical adenoma (n=14), myelolipoma (n=13), adrenal hyperplasia/Cushing's syndrome (n=8), paraganglioma (n=7), adrenal cyst (n=7), Conn's syndrome (n=2), adrenal carcinoma (n=2), and miscellaneous (n=4). Of 125 patients operated, 93 had undergone open adrenalectomy (OA) and 32 had undergone laparoscopic adrenalectomy (LA). Tumour size ranged from 1.5 to 8.4 cm with a median (IQR) of 4.5(2.7) in LA, and 2.4 to 13 cm with a with a median (IQR) of 6.7(4.5) in OA. Compared to OA, patients who underwent LA had lesser tumour size, shorter surgery time, lesser blood loss, earlier drain removal, earlier feeding, earlier ambulation and earlier return to work. The mean (±SD) hospital stay for LA was 4.34±1.7 days compared to 7.3±4.0 days for OA (P=0.001).

CONCLUSION: Pheochromocytoma is the commonest functional adrenal tumour whereas non-functional adenomas constitute most of incidentalomas encountered in a tertiary care hospital practice of a developing country like ours. Though still on learning curve, there is a clear trend in recent times for preferring laparoscopic over open adrenalectomy.