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Abstract

Background

Controversy exists as to whether laparoscopic adrenalectomy should be performed for malignant or potentially malignant tumours affecting the adrenals.

Methods

This was a retrospective analysis of all patients undergoing laparoscopic adrenalectomy at this institution from 1993 to 1999. Patients were classified by their preoperative diagnosis and analysed with respect to their final pathological diagnosis, operation and postoperative course.

Results

Some 121 patients underwent 133 laparoscopic adrenalectomies. Preoperative classification was type I (benign disease; 67 patients), type II (possibly malignant disease; 46 patients) and type III (malignant disease; eight patients). After operation, 11 patients had malignancy on pathological diagnosis including all eight patients with known preoperative malignancy (one adrenocortical carcinoma (3 × 3 cm) presenting as a virilizing tumour, two neuroblastomas, one lymphoma, one bilateral staged adrenalectomy for metastatic colon cancer, two metastatic lung cancers and one metastatic renal cell carcinoma). One patient with adrenocortical cancer (8 × 6 cm) had incorrect preoperative classification by cytology (type I; oncocytoma). Two of 14 patients with Cushing's adrenal tumour (type II) had adrenocortical cancer (12 × 9 cm and 3 × 3 cm). Mean length of stay was 1·8 days in patients with malignancy. No procedure was converted to open adrenalectomy and no significant complications were encountered. Only the four patients with adrenocortical carcinoma had a recurrence (two required open re-resection 3 months and 2 years after initial operation, one had laparoscopic re-resection 2 years after operation for local recurrence and one presented with recurrence 1 year after operation).

Conclusion

Forty-five per cent of patients undergoing laparoscopic adrenalectomy may be classified as having potentially malignant disease (type II or III). Most malignant tumours of the adrenals can be treated laparoscopically, but adrenocortical carcinomas are at high risk of recurrence after laparoscopic adrenalectomy. © 2000 British Journal of Surgery Society Ltd