Background: At the present time, the precise indications for laparoscopic surgery of adrenal incidentaloma
(AI) have yet to be completely clarified. The most controversial issue is the role of laparoscopy
in the treatment of potentially malignant and large adrenal masses. Trying to address these
questions, we retrospectively examined a group of patients with AIs.
Materials and Methods: Forty-two patients with AIs who were laparoscopically treated since 1995
were enrolled in this study. The patients were divided into two groups: the 27 patients of the immediate
surgery (IS) group were operated on immediately, whereas the 15 subjects in the delayed surgery
(DS) group needed further evaluations and/or a follow-up period before surgery. Surgical timing for
both groups was decided according to a widely accepted decision-making algorithm. Many outcome
parameters of laparoscopy (operative time, blood loss, conversion rate, time to liquid and solid food
nutrition, drainage removal, resumption of normal bowel habits, and average hospital stay) were analyzed
in the two groups. The subjects had AIs of various sizes and different histotypes.
Results: Patients in the DS group had a higher risk for malignancy. The definitive pathology revealed
a malignant biology in 26.6% of DS vs. 0% of IS cases. No difference in the outcome parameters
of laparoscopy was observed between the two groups or among pathologically different AIs.
A significant correlation was found between the operative time and the size of the AI (r = 0.836,
P < 0.001, linear regression test).
Conclusion: Our study shows that laparoscopy is feasible and safe for AIs, regardless of the preoperative
probability of malignancy. The size of the AI was the only determinant for choosing a laparotomy.
Further long-term studies are necessary to confirm the laparoscopic efficacy in terms of
oncologic safety.
