Minimally Invasive Surgery for Adrenal Masses in Children: Results of a Two European Centers Survey and Literature Review.

Abstract

Background: Minimally invasive surgery (MIS) for adrenal pathologies in children is still developing because of its low incidence in pediatric population and the discrepancy between the big volume of the masses and the reduced child's size especially in younger patients. In the literature, there are no guidelines about the use of laparoscopic andrenalectomy in children. The aim of this study is to evaluate the outcomes of MIS through a bicenter data analysis in order to propose a standardized protocol. Materials and Methods: Children who underwent minimally invasive adrenalectomy performed at two European Departments of Pediatric Surgery between 2000 and 2020 were included in this study. Data were collected and analyzed using X-square, Fisher tests, and multiple regression model. Results: Thirty-four patients (38 adrenal masses) were included. Mean age was 52 months (3-176). Median lesion diameter was 60 mm (40-125 mm). Histological examination revealed 24 neuroblastomas (NBs), 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 transperitoneal in all patients. Mean operative time was 108 minutes for unilateral lesions and 270 minutes for bilateral ones. Mean hospital stay was 4.4 days. No major intraoperative complications were observed. 21.05% NBs were preemtively approached with a laparoscopic access and were converted to open surgery. Median follow-up was 88 months (24-264). Four patients affected by neuroblastoma reported metastatic dissemination and three died. Conclusions: Pediatric minimally invasive adrenalectomy is a safe and effective procedure, allowing surgeons to reduce the size of incision starting the dissection of the masses, and it has low rate of complication if we consider small masses. The only absolute contraindication is persistent image-defined risk factors for NBs. It should be considered as the first-line treatment for selected adrenal masses in centers with good experience in laparoscopy.