Laparoscopic approach of pediatric adrenal tumors.

Abstract

To analyze the role of laparoscopic surgery for the management of pediatric adrenal tumors (AT). Retrospective analysis of children diagnosed with AT, operated laparoscopically during 2003-2020. The strategy differed according to tumor extension. AT < 6cm were resected. Locally advanced tumors (L2) or > 6cm were biopsied. N = 28. Complete tumor resection (R0) in 20 (71%), tumor biopsy in 8 (R2). Age (median): 28.8months (2months-18years). 14/28 left-sided, 2 bilateral. Median operating time: 78min (45-180). Mean tumor size (for resections): 4cm (2.5-6). Tumor pathology: neuroblastoma (n = 17), Ganglioneuroma (n = 7), Adrenocortical carcinoma (n = 1), Osteosarcoma metastasis (n = 1), Pheochromocytoma (n = 1), Venous malformation (n = 1). Mean hospital stay: 2.5days (1-3). Mean follow up: 65.5months (24-192). Overall survival and event-free survival were 86 and 75%, respectively (5years event-free survival for neuroblastoma: 33% [intermediate risk], 16.6% [high risk]. No surgery-related mortality. Laparoscopic surgery for adrenal tumors is safe. Laparoscopic biopsy is useful for unresectable tumors when a percutaneous approach is not possible. With the proposed selection criteria, the laparoscopic approach should be the first option for resection of small and localized AT in pediatrics.