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A comparison of robotic and laparoscopic minimally invasive adrenalectomy for adrenal malignancies

  • 2021 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Although guidelines recommend open adrenalectomy for most resectable adrenal malignancies, minimally invasive adrenalectomies are performed. Robotic adrenalectomies have become more popular recently, but there is a paucity of literature comparing laparoscopic and robotic resections.

Methods

Patients who underwent a planned minimally invasive adrenalectomy for adrenal malignancies (adrenocortical carcinoma, malignant pheochromocytoma, other carcinoma) were identified in the National Cancer Database. The primary outcome was the conversion rate from minimally invasive to open. Other post-operative outcomes and survival were compared.

Results

416 patients (76.5%) underwent a laparoscopic adrenalectomy and 128 (23.5%) underwent a robotic operation. Demographics and clinical characteristics were similar. Approximately 19% of tumors resected by a minimally invasive approach were > 10 cm. The intra-operative conversion rate was decreased among robotic adrenalectomies relative to laparoscopic on univariate (7.8% vs. 18.3%, p = 0.005) and multivariable (odds ratio 0.39, p = 0.01) analyses. Using marginal standardization, there was a stepwise increase in the conversion rate as tumor size increased (< 5, 5–10, > 10 cm) for laparoscopic (7.5%, 18.0%, 33.2%) and robotic (3.1%, 8.3%, 17.3%) adrenalectomies. Operations which required conversion had a greater margin positivity rate, greater length of stay, and an association with poor overall survival.

Conclusion

In contrast to most clinical guidelines, minimally invasive adrenalectomies are being performed on large malignant tumors. A laparoscopic approach was associated with a greater conversion rate and subsequent poor outcomes. If a surgeon is not planning an open adrenalectomy, but adrenal malignancy is a possibility, robotic adrenalectomy may be the preferred approach for resectable adrenal tumors.

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Authors and Affiliations

  1. Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106-5011, USA

    Jonathan J. Hue, Katherine Bingmer, Lauren Drapalik, John B. Ammori, Scott M. Wilhelm, Luke D. Rothermel & Christopher W. Towe

  2. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Peter Ahorukomeye

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  1. Jonathan J. Hue
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Correspondence to Christopher W. Towe.

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Dr. Towe discloses that he is a consultant to Sig Medical, Zimmer Biomet, Medtronic, and Atricure, but that these relationships have not influenced the work or its conclusions. The other authors have no disclaimers, sources of funding, or financial relationships that could inappropriately influence this work and its conclusions.

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Hue, J.J., Ahorukomeye, P., Bingmer, K. et al. A comparison of robotic and laparoscopic minimally invasive adrenalectomy for adrenal malignancies. Surg Endosc 36, 5374–5381 (2022). https://doi.org/10.1007/s00464-021-08827-x

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  • DOI: https://doi.org/10.1007/s00464-021-08827-x

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