Thoracoabdominal approach to large adrenal tumors – when laparoscopic adrenalectomy is not enough: a retrospective four-year study

Introduction : Laparoscopic adrenalectomy is considered to be the gold standard approach in the field of adrenal surgery. This technique offers advantages of great importance compared to variant laparotomy techniques. Notwithstanding, a technique that needs to be mentioned is the thoracoabdominal approach which facilitates the anatomic exposure of the retroperitoneum, adrenal gland, and great vessels and is strongly recommended for the surgery of large, malignant adrenal tumors. Aim : The objective of this study is to evaluate the effectiveness and outcomes of the thoracoabdominal approach in adrenal surgery for large adrenal tumors. By presenting our results and experiences, we aim to highlight the advantages of this technique in providing optimal anatomic exposure of the retroperitoneum, adrenal gland, and great vessels, and to establish its role as a viable alternative to laparoscopic adrenalectomy in complex cases. Materials and methods : We reviewed retrospectively the data of our patients admitted to our Surgical Department and treated surgically with the thoracoabdominal incision, performed by a single surgeon at our tertiary care center, over the period 01/01/20-31/12/23. Results : All patients had large retroperitoneal masses of varying complexity, requiring maximal surgical exposure. Seventeen patients in total underwent operation with the indication of unilateral adrenal tumor. Five of those patients underwent a laparoscopic tumor resection, while 12 patients were treated by thoracoabdominal approach. Our study group included 7 women (58%) and 5 men (42%), with average age 57 years. The mean maximum tumor diameter was 10.8 cm. Conclusion : The advantages of the thoracoabdominal approach regarding the exposure of the operative field in challenging cases, together with the low incidence of complications noted in our experience, render this technique an excellent alternative if indicated.