Surgical Management of Benign Adrenal and Extra-Adrenal Tumors: A Single Centre Experience

Background: Adrenal and extra-adrenal masses are rare tumours, tricky to find like a needle in a haystack and have a dramatic presentation. They can be benign or malignant, are notable for their tendency to overproduce catecholamines. The incidence of adrenal incidentaloma (AI) ranges from 3-5% to upto 10% in elder population. 70% are non-functional adenomas (NFAI) and rest 30% are functional lesions. The need for surgery is inevitable due to the deleterious effects of the unbalanced catecholamines levels in the body produced by these tumours and uncommonly due to their malignant potential. Laparoscopy is feasible, safe and is associated with lesser perioperative morbidity. Study Design: A retrospective analysis of all the patients admitted at our centre with diagnosed adrenal and extra-adrenal masses who underwent operative management at our institution between August 2017 and September 2020. We present our, discuss the technical prospects of the procedure and surgical outcomes. Results: A total of 20 patients underwent surgery for adrenal and extra-adrenal masses. The LTA group consisted of 17 cases (85%) with 11 male patients and 6 female patients with a mean age of 39.11 ? 16. 2 years (range 12-65 years). Three cases underwent OA where all were male with a mean age of 33.7 ? 12.68 years (range 21-51 years). Amongst the LTA group, tumour was located on the left side in 10 cases (58.8%) and on right in 7 cases (41.2%) while in the OA group, left, right and bilateral lesion had 1 case each. Amongst the LTA group, 4 (23.5% of lap. cases) were converted to open. The mean tumour size was 6.15 ? 3.8 cms (range 3-9cms) in the LTA group and 10.87 ? 5.0 cms (range 6-19 cms) in OA group, mean operative time was 131.7 ? 22.8 minutes (range 90-160) for the LTA group and 146.67 ? 29.5 minutes (range 105-170) for OA while mean duration of stay was 5.2 ? 2.3 days (range 3-10) for LTA and 6.7 ? 1.7 days (range 5-9) for OA. Conclusion: Laparoscopic lateral transperitoneal adrenalectomy offers excellent visualization and outcomes in terms of diligent recovery and cosmesis. It is a safe and effective technique having a reduced operative time, fewer hemodynamic instability, post-operative pain, early mobilisation, need for perioperative blood transfusion, post-operative complications, mean duration of hospital stay and subsequent monetary burden.