Comparative Outcomes Of Laparoscopic Versus Open Adrenalectomy For Adrenal Masses Larger Than 6 Centimeters: A Retrospective Cohort Study

Background: The optimal surgical approach for large adrenal masses exceeding 6 centimeters remains controversial. While laparoscopic adrenalectomy has become the gold standard for smaller masses, concerns persist regarding its safety and oncological adequacy for larger lesions. This study compared perioperative and oncological outcomes between laparoscopic and open adrenalectomy for adrenal masses larger than 6 centimeters. Methods: A multicentric retrospective analysis was conducted of 34 patients who underwent adrenalectomy for masses ≥6cm between January 2020 and December 2023. Patients were divided into laparoscopic (n=16) and open (n=18) groups. Primary outcomes included operative time, blood loss, conversion rate, complications, and length of hospital stay. Secondary outcomes encompassed ICU requirements and pathological diagnoses. Results: Mean mass size was 7.6±1.8cm in the laparoscopic group and 8.2±2.1cm in the open group (p=0.385). Laparoscopic approach demonstrated significantly reduced blood loss (120±90mL vs 340±210mL, p<0.001) and shorter hospital stay (3.4±1.2 vs 6.2±2.1 days, p<0.001). One conversion occurred (6.3%) in a hemorrhagic cyst case due to dense adhesions and bleeding. Myelolipoma was the most common diagnosis (58.8%), followed by pheochromocytoma (17.6%). All pheochromocytoma patients required postoperative ICU monitoring. No mortality occurred in either group. Conclusion: Laparoscopic adrenalectomy for carefully selected adrenal masses larger than 6 centimeters is feasible and safe, offering superior perioperative outcomes. The high prevalence of myelolipomas in our population warrants consideration in surgical planning