Laparoscopic adrenalectomy in the Campania region in the period 2006-2010: a multicentric study of 148 consecutive patients.

Purpose The aim of this study is to compare the results of two multicenter studies of patients with adrenal disease treated with laparoscopic adrenalectomy in the Campania region (Italy) between January 2006 and December 2009 and between January 1992 and December 2005 and to evaluate the differences between the two series. Methods The data regarding 148 patients was obtained using questionnaires mailed or e-mailed in early 2010 to several surgical units operating in the Campania region. Three Units of Endocrine Surgery and 2 Units of General Surgery participated in the audit. The data was analyzed and compared to a previously published series of 250 patients from the same authors. Statistical analysis was performed with SPSS software. Results The definitive histology exams showed that the number of primary adenocarcinomas of the adrenal glands identified preoperatively as incidentalomas < 6 cm in size was smaller (1/68 - 1.4%) than the number reported in the literature. Most of the primary malignant adrenal tumors found were > 6 cm in size (3/4 - 75%). In the second series, intraoperative complications, operative times, and conversion rates were significantly reduced. There was no difference between the two series, in the Endocrine Surgery and General Surgery units, as regards indications for performing an adrenalectomy. Conclusions Laparoscopy can be considered a gold standard for lesions > 10 cm in size, but surgery should not be insisted upon every time an incidentaloma is detected through imaging. The role of the laparoscopic approach to primary adrenal malignancies is still under discussion, but small metastastic lesions < 6 cm in size may be treated with laparoscopy.