Navigating Large Adrenal Tumors: Insights from Minimally Invasive Surgery at a Tertiary Referral Center

Abstract

Context:

Large adrenal tumors (LATs) pose challenges in clinical management, with varied approaches and outcomes reported.

Aims:

To analyze the surgical outcomes of large adrenal tumors and compare the minimally invasive and open approaches.

Settings and design:

Retrospective analysis of large adrenal tumors operated at a tertiary care center.

Methods and material:

Tumors ⩾6 cm on preoperative imaging were included. Data encompassing demographics, preoperative evaluations, surgical techniques, perioperative outcomes, and histopathological findings were analyzed. Receiver Operating Characteristic (ROC) analysis was used to determine a tumor size threshold predictive of malignancy. Statistical analysis was performed using SPSS v26.0.

Results:

The mean age was 46.9 years, with a female predominance (70%). Incidental findings accounted for 52.2% of cases, while pain was the most common presenting symptom. Functioning tumors comprised 52.17% of cases, with no significant association between functioning status and malignancy risk. ROC analysis identified 7.4 cm as a malignancy-predictive cutoff (AUC = 0.77, p = 0.027). Laparoscopic and open approaches demonstrated comparable outcomes, with laparoscopy associated with lesser blood loss (90 vs 232 ml, p = 0.001) and significantly fewer major complications (0% vs 17.3%, p = 0.022).

Conclusions:

Our study underscores the importance of vigilant evaluation and multidisciplinary management in LATs. Tumor size emerged as a critical determinant of malignancy, with laparoscopic surgery offering safe and comparable outcomes to open surgery in selected cases. Prospective studies are needed to validate these findings.