Twenty years experience of laparoscopic adrenal surgery in the west of Scotland

Abstract

Background: Adrenal tumours are common and can vary from benign non-functional/functional adenomas to malignant tumours. Historically, tumours were removed via an open approach however the laparoscopic approach is now the procedure of choice. The aim of this study was to describe the experience and safety of laparoscopic adrenal surgery in a tertiary referral centre. Methods: Patients undergoing adrenal surgery were retrospectively analysed over a 20-year period. Data collected included demographics, indication for surgery, size and functionality, imaging performed, surgical approach, complications and final pathology. The main outcomes of interest were to describe the varying pathologies encountered and complication rates, assess the feasibility of the laparoscopic approach and to highlight trends over this 20-year period. Results: Four hundred and forty-six patients (264 F/182 M) were included in our analysis. Laparoscopic adrenalectomy was performed in 91% of patients (n=406). The conversion rate was 6% (n=25). The different aetiologies encountered were: Phaeochromocytomas/paragangliomas (n=126), Conn’s syndrome (n=57), Cushing’s syndrome (n=76), Adrenocortical cancers (n=31), oncocytomas (n=4), non-functioning adenomas (n=80), metastatic tumours (n=53), gangliomas/schwanomas (n=7) and miscellaneous tumours (n=12). There was an increase in the number of patients undergoing adrenalectomies over this period 1999–2003 (n=62), 2004–2008 (n=114), 2009–2013 (n=147) and 2014–2018 (n=123). The overall complication rate was 16%. Conclusions: The laparoscopic approach may be a feasible option for adrenal tumours irrespective of pathology and size with low conversion and complication rates. Given the increasing trend of adrenal pathology, patients should be managed by an experienced multidisciplinary team in a tertiary referral centre in order to improve outcomes.