Robotic Versus Laparoscopic Retroperitoneal Resection of Large Adrenal Tumors: A Propensity Score-Matched Cohort Analysis

Abstract

Abstract Background Laparoscopic adrenalectomy is the first-line treatment for benign adrenal tumors, but when the tumor is larger than 6 cm, its resection is controversial. The purpose of this study was to understand and compare the effects of robot-assisted and laparoscopic adrenalectomy on large adrenal tumors via a retroperitoneal approach. Methods We reviewed the perioperative data of patients who underwent robot-assisted and laparoscopic retroperitoneal adrenalectomy at the First Affiliated Hospital of Nanchang University between 2011 and 2020. After propensity score matching, the clinical data were analyzed by using the t test and chi-square test, as well as univariate and multivariate analysis. Results There is no significant difference between the two groups in operation time (RRA 191 ± 136min vs. 165 ± 83.8min, P = 0.158), postoperative complications (18.2% vs. 14.4%, P = 0.536), estimated blood loss (181 ± 167ml vs. 214 ± 341ml, P = 0.359), conversion rate (1.5% vs. 1.5%, P = 1.000) and postoperative hospital stay (6.55 ± 2.12 vs. 6.06 ± 2.39, P = 0.149). Multivariate analysis showed that larger tumors were associated with longer operative times. Female gender and postoperative complications were associated with longer hospital stays. BMI, conversion, history of abdominal surgery, and pathological type of patients affected the occurrence of postoperative complications. Conclusion it is safe and feasible for experienced surgeons to perform robotic adrenalectomy and laparoscopic adrenalectomy after the possibility of infiltration is ruled out on imaging before operation. However, when there is evidence of infiltration, we still recommend open surgery.