Clinical Outcomes of Adrenalectomy in a Resource-Limited Setting: Predictors of Complications and Surgical Challenges

Background: Adrenalectomy is the definitive treatment for adrenal tumors, and open and laparoscopic approaches are used depending on the tumor characteristics. Limited data exist on the indications, outcomes, and challenges of adrenalectomy in developing countries, particularly in the Middle East. This study aimed to evaluate the clinical presentation, tumor characteristics, surgical approaches, and postoperative outcomes of adrenalectomy in a resource-limited setting. Methods: This prospective descriptive study included 43 patients who underwent adrenalectomy at tertiary care hospitals in Yemen between January 2015 and April 2020. Data on demographic and clinical characteristics, tumor characteristics, surgical details, and postoperative outcomes were collected and analyzed. Statistical comparisons were conducted using SPSS version 20, with p < 0.05 considered statistically significant. Results: A total of 49 adrenalectomy procedures were performed. The mean age of the patients was 29.5 ± 15.4 years, and 65.1% were female. Hypertension was the most common presenting symptom (48.8%), followed by loin pain (30.2%) and incidentaloma (14%). Functional tumors accounted for 65.1% of the cases, with pheochromocytoma being the most common type (48.8%). Open adrenalectomy was performed in 88.4% of the patients, whereas laparoscopic adrenalectomy was performed in 11.6%. Tumors managed with laparoscopic surgery were smaller (4.5 ± 1.2 cm) and associated with shorter hospital stays (4 ± 1 days) than those managed with open surgery (8.7 ± 3.9 cm; 7 ± 2 days; p < 0.001). Malignant tumors were observed in 16.3% of the cases, all of which were >6 cm. Postoperative complications occurred in 16.3% of patients, and the mortality rate was 2.3%. Conclusion: Open adrenalectomy remains the preferred approach in Yemen, largely because of late presentation of large tumors and limited laparoscopic expertise. Laparoscopic adrenalectomy offers significant advantages for smaller tumors, including shorter hospital stays and lower complication rates. Efforts to improve laparoscopic training and healthcare infrastructure are crucial for enhancing adrenalectomy outcomes in resource-limited settings. Further studies with larger cohorts are needed to refine surgical decision-making and optimize patient care.