Transperitoneal Laparoscopic Adrenalectomy in Children - Initial Experience in an Emerging Tertiary Center in Eastern India.

Abstract

Background: Adrenal tumors account for 0.2%-1% of all tumors in children. They can be benign or malignant, secretory or nonsecretory, and can arise either from the cortex or medulla. The common indication in children undergoing laparoscopic adrenalectomy (LA) is neuroblastic tumors (neuroblastoma, ganglioneuroma, and ganglioneuroblastoma).

Methodology: This is a retrospective observational study conducted from October 2021 to February 2024 (28 months) in the pediatric surgery unit at our institute. All children under 18 years of age referred to us for surgery of adrenal mass were included in this study. Any children with image-defined risk factors (IDRFs + ve) were excluded from the study. Children were worked up and managed according to the protocol of the Institute Pediatric Tumor Board. The laparoscopic transperitoneal approach was used for all. All adrenal lesions with IDRF +ve were excluded from the study and resected via open approaches.

Results: A total of six patients were included (three each in male and female groups). The mean age was 31 months (range 22 months-39 months). There were two cases of neuroblastoma, and one each of pheochromocytoma, adrenal adenoma, adrenocortical carcinoma, and paraganglioma. The median follow-up period was 24 months (range 7-32 months). On follow-up, there are no recurrences reported till date with zero mortality.

Conclusion: LA is a safe and feasible operation in children without any IDRF. It should be preferred in children with small lesion with good plane between the tumor and normal tissues. For larger lesion and ACC, it should be used cautiously to prevent spillage. Thought difficult, laparoscopic resection is a safe approach for these adrenal tumors.