Feasibility and Safety of Laparoscopic Adrenalectomy in Children: Special Emphasis on Neoplastic Lesions

Abstract

Laparoscopic adrenalectomy (LA) in children became a viable option for the resection of adrenal lesions. Few reports have been published in the last few years documenting its safety and feasibility. In this paper, we report our experience with LA over the last 10 years, with special emphasis on malignant lesions. A retrospective chart review was undertaken for patients managed with LA from 1997 to 2006 at King Faisal Specialist Hospital and Research Center. Demographic and clinical data were retrieved and descriptive data were generated. Twenty-nine patients were managed with LA at our institution over that period. There were 16 females and 13 males with a median age of 3 years. Adrenal lesions were left sided in 15, right sided in 11, and bilateral in 3 patients. Twenty-one patients had malignant lesions, while 8 had benign lesions. Lesions ranged in size from 2.8 to 7 cm in diameter. There were 3 conversions (10%) to the open technique. Resection margins were positive for tumor in 5 cases (17%), and all had stage IV neuroblastoma. Follow-up range was from 9 months to 9.5 years (9 months to 6.3 years for malignant lesions). There were no major postoperative complications and no port-site metastasis. Three patients had local recurrence, 2 of them had free resection margins. One patient managed for bilateral neuroblastoma has stable residual disease 17 months after resection. Hospital stay ranged from 2 to 4 days. At the time of this report, 3 patients with neuroblastoma had died with progressive metastatic refractory disease. Our data have shown the feasibility, safety, and effectiveness of LA for adrenal lesions, including malignant tumors. The relatively long follow-up data regarding the malignant lesions attest to its role in the management of such lesions. Appropriate selection criteria and appropriate laparoscopic surgical expertise are required to ensure its success.