Impact of minimally invasive surgery on adrenalectomy for incidental tumors: Comparison with laparotomic technique

Background. To compare laparoscopic and laparotomic techniques for the excision of incidental adrenal tumors. Materials and Methods. Twenty patients with silent adrenal tumor underwent adrenalectomy or tumor excision through the laparotomic (LPT Group: 12 cases) or laparoscopic (LPS Group: 8 cases) approach. LPT Group and LPS Group were comparatively analyzed in terms of age, gender, Body Mass Index (BMI), concomitant diseases, previous upper abdominal surgery, tumor side and size, type of operation (excision vs adrenalectomy), associated procedures, and pathology. The two groups were then compared for intra/postoperative complications, length of operation, and postoperative ileus, pain, hospitalization. Comparisons were performed also adjusting for variables (BMI, depression, tumor size) unhomogeneously distributed between the two groups. Results. LPT Group and LPS Group were comparable when evaluated for age, gender, BMI, concomitant diseases (except for depression), previous upper abdominal surgery, tumor side, type of operation, associated procedures, and pathology. Tumor size LPT > LPS, p = 0.03) and depression (LPT <LPS, p = 0.04) turned out to be differently distributed between the two groups, and were then considered, as well as the BMI (p = 0.08), in the covariance analysis. Postoperative ileus (LPT vs LPS: 3.5 ± 0.2 days vs 2.3 ± 0.2 days, p = 0.006), pain (LPT vs LPS: 3.0 ± 0.3 days vs 1.7 ± 0.2 days, p = 0.012), and hospitalization (LPT vs LPS: 7.9 ± 1.0 days vs 3.5 ± 0.4 days, p=0.0002) were statistically shorter in the LPS Group; the length of operation, even if shorter in the LPS Group (LPT vs LPS: 2.9 ± 0.3 hours vs 2.5 ± 0.3 hours), did not reach statistical significance (p = 0.12). Results were confirmed by covariance analysis. Conclusions. Laparoscopy seems a safe and effective approach which permits adrenal surgery with lower surgical stress than laparotomic technique.