Comparison of hand-assisted laparoscopic adrenalectomy vs. laparoscopic adrenalectomy for large pheochromocytomas: a retrospective study.

Background: It remains uncertain whether hand-assisted laparoscopic adrenalectomy (HAL) has advantages in treating large pheochromocytomas (PHEOs). This study aimed to assess the feasibility and safety of HAL compared to laparoscopic adrenalectomy (LA).

Methods: We conducted a retrospective study on patients with PHEOs ≥6 cm who received HAL (n=16) and LA (n=20) at Shandong Provincial Hospital from January 2020 to January 2023. The two groups were balanced into 8 pairs using propensity score matching (PSM). Perioperative parameters and long-term follow-up outcomes were compared between the two groups.

Results: After adjusting for balance through PSM, patients in the HAL group had shorter operation time (105.00±18.52 vs. 147.50±7.07 minutes, P<0.001), faster bowel recovery days (1.0 vs. 2.0 days, P=0.043), and shorter postoperative hospital stays (5.00 vs. 7.50 days, P=0.01). The differences in blood pressure improvement within 3 months postoperatively, and recurrence and metastasis between the two groups (75.00% vs. 62.50%, P>0.99; 12.50% vs. 12.50%, P>0.99) were not statistically significant.

Conclusions: This study suggested that HAL was feasible and safe for patients with large PHEOs. Both HAL and LA showed comparable perioperative and long-term follow-up results.