Comment on: Laparoscopic transperitoneal adrenalectomy for adrenal tumours of 6 cm or greater: A single-centre experience

Dear Editor, I read the article published by Öz et al. in 2023[1] and would like to thank the authors for their valuable contribution to the literature. I appreciate their efforts on this original study. In this study, they shared their experience with laparoscopic transperitoneal adrenalectomy (LA) for adrenal tumours measuring 6 cm or larger. They stated that LA can be considered the treatment of choice for both small and large adrenal tumours up to 15 cm. However, they also noted that adrenal tumours ≥8 cm are associated with a higher conversion rate to open surgery. In the pre-operative evaluation of their patients, they reported that four patients in the large tumour group (≥6 cm) were suspected of malignancy. Post-operative pathology results confirmed that three patients with tumours measuring 7 cm, 8 cm and 9 cm had adrenocortical carcinoma, while one patient with an 8 cm tumour was diagnosed with malignant pheochromocytoma. I would like to thank the authors again for this valuable work and ask a question. According to adrenal tumour guidelines,[2] open adrenalectomy is recommended for tumours with a high risk of malignancy due to the increased risk of local recurrence and peritoneal spread when performed laparoscopically.[3] Achieving negative surgical margins and avoiding tumour capsule rupture are crucial in these cases. A minimally invasive approach may carry a higher risk of local recurrence and peritoneal dissemination.[4] Given that guidelines and literature recommend open surgery for adrenal masses suspected of malignancy regardless of size, I would like to ask the authors what their rationale was for choosing a laparoscopic approach in these patients with adrenal tumours measuring 7 cm or larger and suspected malignancy. I would like to thank the authors again for their contributions to the literature and this valuable study. Sincerely. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.