Lateral transperitoneal versus retroperitoneal laparoscopic adrenalectomy for large (≥ 50 mm) pheochromocytoma: a single-centre retrospective study

Laparoscopic adrenalectomy (LA) has gained popularity for the surgical treatment of large pheochromocytomas in recent years. However, the perioperative outcomes of the lateral transperitoneal and lateral retroperitoneal approaches remain uncertain. In addition, owing to the catecholamine-secreting nature of pheochromocytoma, intraoperative haemodynamic instability is an important clinical consideration when comparing these approaches. The primary objectives of this study were to compare perioperative and intraoperative haemodynamic outcomes between the two approaches. Based on tumour-size thresholds used in previous studies, tumours with a maximum diameter of ≥ 50 mm were defined as large adrenal pheochromocytomas in the present study. Between January 2011 and October 2023, 93 patients with large adrenal pheochromocytomas underwent lateral transperitoneal laparoscopic adrenalectomy (LTLA, n = 67) or lateral retroperitoneal laparoscopic adrenalectomy (LRLA, n = 26). Patient data were retrospectively reviewed to compare perioperative and intraoperative haemodynamic outcomes. Propensity score matching (PSM) was performed using eight selected baseline clinical covariates: age, sex, body mass index, symptomatic tumour status, preoperative hypertension, preoperative α-blocker use, tumour size, and tumour side. Optimal 1:1 matching yielded 21 matched pairs. Before PSM, tumours were larger in the LTLA group than in the LRLA group (70 [50 − 115] mm vs. 57.5 [50 − 110] mm, P = 0.002). A higher proportion of patients in the LTLA group required intraoperative administration of β-blockers (86.57% vs. 65.38%, P = 0.020). PSM substantially improved covariate balance. After PSM, no statistically significant differences between the two surgical approaches were detected in perioperative and intraoperative haemodynamic outcomes. In this single-centre retrospective study, the LRLA group showed a potentially more favourable intraoperative heart-rate profile. However, no statistically significant differences were detected between LTLA and LRLA in perioperative and haemodynamic outcomes after PSM. Given the small matched analysis cohort and inadequate statistical power, clinically important differences between the approaches cannot be ruled out.