Outcomes of Open Adrenalectomies for Large Adrenal Masses: A case series from a Single-Center Experience

Introduction: Large adrenal tumors (> 8cm) are one of the indications for open adrenalectomy. These tumors are also associated with an increased risk of incomplete resection, injury to surrounding structures, and postoperative complications. We review the outcomes of open adrenalectomy for large adrenal tumors in a single center.Patients and Methods: This was a retrospective review of open adrenalectomies for large adrenal tumors(> 8cm) done from 2011 to 2024. Data on clinical presentation, site, and size of the tumor, approach to tumor excision, need for ancillary procedures, histological diagnosis, and postoperative complications using Clavin Dindo Classification and follow-up was retrieved.Results: A total of 10 patients were reviewed with a mean age of 27 ± 4 years. The male-to-female ratio is 3:1. 70% of the patients presented with complaints of Flank pain and flank swelling, 20% had associated symptoms of increased adrenal function, and 10% had an incidentaloma. 90% of these large tumors were in the right with an average size of 16cm and a weight of 859g. The surgical approach was anterior transperitoneal in all the patients, with 30% requiring ipsilateral nephrectomy and 20% having an IVC repair along with the adrenalectomy. 60% of the tumors were pheochromocytoma, 30% adrenocortical carcinoma, and 10% Mature ganglioneuroma. 20% had Grade II and Grade III complications, and 10% had a Grade IV complication. All patients underwent a complete resection and showed no recurrence, with a median follow-up period of 7 years.Conclusion: Open Adrenalectomy for large adrenal tumors using the anterior transperitoneal approach is acceptable with minimal complications in our series.