Minimally invasive surgery for adrenal masses in children: results of a bi-centric survey and Literature review.

Abstract

Background Minimally invasive surgery for adrenal pathologies in children is still developing because of the low incidence of adrenal masses in pediatric population and the discrepancy between the size of the mass and the child’s one. In Literature there are no any guidelines about the use of laparoscopic andrenalectomy in children. The aim of this study is to evaluate the outcomes of minimally invasive surgery through a bi-center data analysis in order to propose a standardized protocol. Materials and methods Children who underwent minimally invasive adrenalectomy between 2000 and 2020 performed by two expert Pediatric surgeons at two European departments of Pediatric Surgery were included in this study. Data were collected and analyzed using X-square, Fisher tests, multiple regression model. Results 34 patients (38 adrenal masse)s were included. Mean age was 52 months 3–176]. Median lesion diameter was 60 mm [40-125mm]. Histological examination revealed 24 neuroblastomas, 11 pheochromocytomas, 1 teratoma, 1 adrenal cyst and 1 Myelolipoma. Laterality was 52.6% left, 36.8% right and 10.5% bilateral. Surgical access was trans-peritoneal in all patients. Mean operative time was 108 min for unilateral lesions and 270 min for bilateral ones. Mean hospital stay was 4.4 days. No major intra operative complications were observed. 21.05% neuroblastomas were preventively approached with a laparoscopic access and were converted to open surgery. Median follow-up was 88 months [24–264]. 4 patients affected by neuroblastoma reported metastatic dissemination and 3 died. Conclusions Pediatric minimally invasive adrenalectomy was a safe and effective procedure, it allows surgeons to reduce the size of laparotomies starting the dissection of the masses and it has low rate of complication if we consider small masses. The only absolute contraindication is persistent IDRF for neuroblastomas. It should be considered the first-line treatment for selected adrenal masses in centers with good experience in laparoscopy.