Laparoscopic Approach Reduces Likelihood of Perioperative Complications in Patients Undergoing Adrenalectomy

Abstract

Laparoscopy has been reported advantageous over the conventional open technique for adrenalectomy. However, most comparative series include the relatively more challenging cases in the open group. The aim of this study is to assess the actual role of laparoscopy in reducing perioperative complications compared to open surgery in patients undergoing adrenalectomy. Between January 1992 and December 2002, we performed 148 adrenalectomies in 138 patients. Depending on the approach, patients were divided into laparoscopic (LA) or open adrenalectomy (OA) groups. Demographics, tumor characteristics, operative data, and outcomes were analyzed. Linear and logistic regressions identified factors influencing perioperative outcomes. Multivariate-adjusted logistic regression assessed independent relationship between factors and perioperative outcomes. A total of 78 cases were performed laparoscopically and 70 open. Patients were matched for age and sex. Tumor size was smaller (3 ± 2 vs 5 ± 3 cm), operative time was shorter (133 ± 65 vs 165 ± 100 min), estimated blood loss was less (114 ± 152 vs 350 ± 417 cc), length of stay was shorter (3 ± 2 vs 7 ± 3 days), and overall complication rate was lower (7% vs 20%) in the LA compared to the OA group. The incidence of cancer in tumors ≥6 cm (31%) was higher than in those <6 cm (4%). All patients with cancer underwent OA. LA was the only factor independently associated with a decreased likelihood of intraoperative bleeding and postoperative pulmonary complications. Large and malignant adrenal tumors are more frequently removed through an open approach. However, this fact has no influence on the advantages of the LA over the OA. Laparoscopy reduces perioperative adrenalectomy perioperative complication rates. It has a positive impact on intraoperative bleeding and postoperative pulmonary complications.