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

Outcomes of Open Adrenalectomies for Large Adrenal Masses: A case series from a Single-Center Experience | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Outcomes of Open Adrenalectomies for Large Adrenal Masses: A case series from a Single-Center Experience Nasir Oyelowo, Aisha Sani Dauda, Abdullahi Sudi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7580783/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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. Large adrenal tumors open adrenalectomies Figures Figure 1 Introduction Surgery for adrenal tumors, though first described in the 17th century by Thornton, has undergone revolutionary changes with the advent of technology. [ 1 ] Laparoscopic adrenalectomy and, more recently, robotic-assisted approach are the commonly used modalities for the removal of adrenal glands. [ 2 ] Though Open adrenalectomies are rarely done today because of the morbidity associated with it as compared to the less invasive approaches, there are specific indications for this approach. [ 3 ] Patients with large tumors > 8cm or tumors with the possibility of local infiltration into adjacent organs or evidence of vascular extension require adequate exposure. As such, an open approach is advocated. [ 4 ] Furthermore, adrenal surgeons should be proficient in the open approach, as conversion from a Laparoscopic or robotic approach to an open approach may be required. However, the number of open adrenalectomies has significantly decreased, with most surgeons performing only a few in a year or throughout their entire surgical career, making training and proficiency difficult. [ 5 ] We hereby present our experience with open adrenalectomies for large adrenal glands to highlight the outcomes of this approach as this procedure shouldn’t be relegated to history and has its place in contemporary surgical practice. Patients and Methods This is a retrospective review of over a decade of open adrenalectomies for large adrenal tumors greater than 8cm performed at a single tertiary center in sub-Saharan Africa. All patients who were operated on from 2011 to 2024 were included in the review. Ethical approval was obtained from the institution's health ethics research committee (IRB 000014024). These patients were managed by a multidisciplinary team comprising surgeons, endocrinologists, chemical pathologists, cardiologists, and anesthesiologists. Preoperative evaluation to determine the functional status of the adrenal glands and fitness for surgery was conducted, and patients with electrolyte imbalances and hypertension were corrected before surgery. A computed tomography scan was performed to characterize the tumor and assess the extent of the disease. Medical records of these patients were reviewed after obtaining informed consent from all eligible patients, and data on clinical presentation, tumor site and size, approach to tumor excision, need for ancillary procedures, histological diagnosis, and postoperative complications were collected and analyzed using descriptive statistics. Results A total of 10 patients were reviewed with a mean age of 27 ± 4 years. The male-to-female ratio is 3:1. Seventy percent of the patients presented with complaints of flank pain and flank swelling, 20% had associated symptoms of increased adrenal function, and 10% were incidentalomas. Ninety percent of these large tumors were on the right side, with an average size of 16 cm and a weight of 859 g. Bilateral resection was not performed in this series. The surgical approach was anterior transperitoneal in all patients, with 30% requiring ipsilateral nephrectomy and 20% undergoing IVC repair along with adrenalectomy. Sixty percent of the tumors were pheochromocytomas, 30% were adrenocortical carcinomas, and 10% were mature ganglioneuromas. Half of the patients experienced complications, as described in Table 1 below. All patients had complete resections, with no mortality in the 30-day postoperative period and no recurrences during a median follow-up of 7 years. Figure 1 below shows a resected giant pheochromocytoma. Post Operative complications following Open adrenalectomies for large adrenal tumors S/NO Claven-Dindo Description Management Frequency 1 Grade II Anemia Blood transfusions 20% 2 Grade III Seroma collection and Deep incisional Surgical site infection Drainage and antibiotics 20% 3 Grade IV Reactionary hemorrhage with hypotension ICU admission blood transfusion and exploration 10% Discussion Adrenalectomy is the treatment of choice for adrenal tumors as it alleviates symptoms and offers the chance of cure when the resection is complete. In developed countries, more than 80% of tumors are incidentalomas. [ 6 ] These are usually benign tumors amenable to laparoscopic or robotic adrenalectomies. In developing countries where the health-seeking behavior is poor, patients commonly present with later stages of the disease, consisting of large tumors with the need for open adrenalectomies. Anterior or posterior approaches may be used for open adrenalectomies. However, in large tumors, the anterior transperitoneal approach provides better exposure of the intrabdominal organs and improved vascular control. This is at the expense of increased postoperative pain, atelectasis, and ileus. In this series, all patients underwent a subcostal transperitoneal approach, with no recorded cases of prolonged ileus or atelectasis, in contrast to a similar 10-year series by Rezkallah et al. in Egypt, which reported 2 out of 9 patients with chest infections following open adrenalectomies. [ 7 ] Splenectomy was not done in these series, possibly because most of the tumors were right-sided. This is, in contrast, to review by Porowicz et al who had more left-sided tumors (54%) and performed a splenectomy in one of them. [ 8 ] This may also explain the need for repair of the inferior vena cava in a patient with a right-sided tumor-infiltrating the vein. Similarly, inferior vena cava dissection was done in all patients with giant (> 10cm) right adrenal tumors by Pedullà et al in Italy. [ 9 ] Half of the patients had a complication following surgery. This is not far-fetched as the disease involves large adrenal glands where extensive dissections are required for the removal of the tumor; however, most of the complications are grade II and grade III based on Claven Dindo classification. The mean hospital stay recorded was 10 days, which is comparable to the 11 days obtained by Wang et al. in Taiwan when comparing the outcomes of open and laparoscopic adrenalectomies. [ 10 ] Conclusion Large adrenal tumors are uncommon in our environment. These tumors are often pheochromocytomas and amenable to open adrenalectomies via the anterior transperitoneal approach. Complications should be anticipated, though rarely life-threatening. Declarations Consent to Participate Declaration: All participants gave informed consent to participate Funding: No support or funding from an organization Conflict of Interest- None Author Contribution NO- concept and writing of the manuscript A.S.D - collected data and data analysisA.S.- data analysis and reviewed the complete manuscript References Zografos GN, Vasiliadis G, Farfaras AN, Aggeli C, Digalakis M. Laparoscopic surgery for malignant adrenal tumors. J Soc Laparoendosc Surg. 2009;13(2):196–202. Otto M. Surgical Treatment of Adrenal Tumors. Polish J Endocrinol. 2015;(April):716–9. Crona J, Beuschlein F, Pacak K, Skogseid B. Advances in adrenal tumors 2018. Endocr Relat Cancer. 2018;25(7):R405–20. Awad A, Salem S, Alshoeiby MH, Ahmed BM, Sayed MM. Primary Adrenal Tumors in Adults Single Institute 10 Years ’. J Trop Dis. 2019;7(4). Thompson LH, Nordenström E, Almquist M, Jacobsson H, Bergenfelz A. Risk factors for complications after adrenalectomy: results from a comprehensive national database. Langenbecks Arch Surg. 2017;402:315–22. Jarolim L, Breza J, Wunderlich H. Adrenal tumours. Eur Urol. 2003;43(1). Elsaify ERWEA. Surgery Research and Practice 10 Years of Experience of a Single Surgeon in Adrenalectomy: Retrospective Review. Int J Surg Res Pr. 2021;8(2):1–6. Aporowicz M, Domosławski P, Czopnik P, Sutkowski K, Kaliszewski K. Perioperative complications of adrenalectomy – 12 years of experience from a single center / teaching hospital and literature review. Arch Med Sci. 2018;14(5):1010–9. Pedullà G, Sapienza P, Paliotta A, Giordano A, Crocetti D, De Toma G. Surgical considerations for removal of giant tumor of the right adrenal. Anticancer Res. 2014;34(9):5087–90. Wang HS, Li CC, Chou YH, Wang CJ, Wu WJ, Huang CH. Comparison of Laparoscopic Adrenalectomy with Open Surgery for Adrenal Tumors. Kaohsiung J Med Sci. 2009;25(8):438–44. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7580783","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":518879548,"identity":"0d453358-3957-42bb-a82c-ec6b86caef4f","order_by":0,"name":"Nasir 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1","display":"","copyAsset":false,"role":"figure","size":733936,"visible":true,"origin":"","legend":"\u003cp\u003eResected Giant Pheochromocytoma\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7580783/v1/67e0e6c9adc740b2bd8a3ad5.png"},{"id":107538077,"identity":"ebdf3fef-afa2-444b-978a-640e3e6182ad","added_by":"auto","created_at":"2026-04-22 11:42:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1108134,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7580783/v1/5cc36d13-b2a9-42af-924e-c046c883dcc0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Outcomes of Open Adrenalectomies for Large Adrenal Masses: A case series from a Single-Center Experience","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSurgery for adrenal tumors, though first described in the 17th century by Thornton, has undergone revolutionary changes with the advent of technology.\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e Laparoscopic adrenalectomy and, more recently, robotic-assisted approach are the commonly used modalities for the removal of adrenal glands.\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e Though Open adrenalectomies are rarely done today because of the morbidity associated with it as compared to the less invasive approaches, there are specific indications for this approach.\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e Patients with large tumors \u0026gt; 8cm or tumors with the possibility of local infiltration into adjacent organs or evidence of vascular extension require adequate exposure. As such, an open approach is advocated.\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e Furthermore, adrenal surgeons should be proficient in the open approach, as conversion from a Laparoscopic or robotic approach to an open approach may be required. However, the number of open adrenalectomies has significantly decreased, with most surgeons performing only a few in a year or throughout their entire surgical career, making training and proficiency difficult.\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e We hereby present our experience with open adrenalectomies for large adrenal glands to highlight the outcomes of this approach as this procedure shouldn’t be relegated to history and has its place in contemporary surgical practice.\u003c/p\u003e"},{"header":"Patients and Methods","content":"\u003cp\u003e This is a retrospective review of over a decade of open adrenalectomies for large adrenal tumors greater than 8cm performed at a single tertiary center in sub-Saharan Africa. All patients who were operated on from 2011 to 2024 were included in the review. Ethical approval was obtained from the institution's health ethics research committee (IRB 000014024). These patients were managed by a multidisciplinary team comprising surgeons, endocrinologists, chemical pathologists, cardiologists, and anesthesiologists. Preoperative evaluation to determine the functional status of the adrenal glands and fitness for surgery was conducted, and patients with electrolyte imbalances and hypertension were corrected before surgery. A computed tomography scan was performed to characterize the tumor and assess the extent of the disease. Medical records of these patients were reviewed after obtaining informed consent from all eligible patients, and data on clinical presentation, tumor site and size, approach to tumor excision, need for ancillary procedures, histological diagnosis, and postoperative complications were collected and analyzed using descriptive statistics.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 10 patients were reviewed with a mean age of 27\u0026thinsp;\u0026plusmn;\u0026thinsp;4 years. The male-to-female ratio is 3:1. Seventy percent of the patients presented with complaints of flank pain and flank swelling, 20% had associated symptoms of increased adrenal function, and 10% were incidentalomas. Ninety percent of these large tumors were on the right side, with an average size of 16 cm and a weight of 859 g. Bilateral resection was not performed in this series. The surgical approach was anterior transperitoneal in all patients, with 30% requiring ipsilateral nephrectomy and 20% undergoing IVC repair along with adrenalectomy. Sixty percent of the tumors were pheochromocytomas, 30% were adrenocortical carcinomas, and 10% were mature ganglioneuromas. Half of the patients experienced complications, as described in Table\u0026nbsp;1 below. All patients had complete resections, with no mortality in the 30-day postoperative period and no recurrences during a median follow-up of 7 years. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below shows a resected giant pheochromocytoma.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003ePost Operative complications following Open adrenalectomies for large adrenal tumors\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eS/NO\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClaven-Dindo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDescription\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eManagement\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade II\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAnemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBlood transfusions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade III\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSeroma collection and Deep incisional Surgical site infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDrainage and antibiotics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade IV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReactionary hemorrhage with hypotension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eICU admission blood transfusion and exploration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAdrenalectomy is the treatment of choice for adrenal tumors as it alleviates symptoms and offers the chance of cure when the resection is complete. In developed countries, more than 80% of tumors are incidentalomas.\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e These are usually benign tumors amenable to laparoscopic or robotic adrenalectomies. In developing countries where the health-seeking behavior is poor, patients commonly present with later stages of the disease, consisting of large tumors with the need for open adrenalectomies. Anterior or posterior approaches may be used for open adrenalectomies. However, in large tumors, the anterior transperitoneal approach provides better exposure of the intrabdominal organs and improved vascular control. This is at the expense of increased postoperative pain, atelectasis, and ileus. In this series, all patients underwent a subcostal transperitoneal approach, with no recorded cases of prolonged ileus or atelectasis, in contrast to a similar 10-year series by Rezkallah et al. in Egypt, which reported 2 out of 9 patients with chest infections following open adrenalectomies.\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e Splenectomy was not done in these series, possibly because most of the tumors were right-sided. This is, in contrast, to review by Porowicz et al who had more left-sided tumors (54%) and performed a splenectomy in one of them.\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e This may also explain the need for repair of the inferior vena cava in a patient with a right-sided tumor-infiltrating the vein. Similarly, inferior vena cava dissection was done in all patients with giant (\u0026gt;\u0026thinsp;10cm) right adrenal tumors by Pedull\u0026agrave; et al in Italy.\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eHalf of the patients had a complication following surgery. This is not far-fetched as the disease involves large adrenal glands where extensive dissections are required for the removal of the tumor; however, most of the complications are grade II and grade III based on Claven Dindo classification. The mean hospital stay recorded was 10 days, which is comparable to the 11 days obtained by Wang et al. in Taiwan when comparing the outcomes of open and laparoscopic adrenalectomies.\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eLarge adrenal tumors are uncommon in our environment. These tumors are often pheochromocytomas and amenable to open adrenalectomies via the anterior transperitoneal approach. Complications should be anticipated, though rarely life-threatening.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eConsent to Participate Declaration: All participants gave informed consent to participate\u003c/p\u003e\n\u003cp\u003eFunding: No support or funding from an organization\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConflict of Interest- None\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eNO- concept and writing of the manuscript A.S.D - collected data and data analysisA.S.- data analysis and reviewed the complete manuscript\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZografos GN, Vasiliadis G, Farfaras AN, Aggeli C, Digalakis M. Laparoscopic surgery for malignant adrenal tumors. J Soc Laparoendosc Surg. 2009;13(2):196\u0026ndash;202.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOtto M. Surgical Treatment of Adrenal Tumors. Polish J Endocrinol. 2015;(April):716\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCrona J, Beuschlein F, Pacak K, Skogseid B. Advances in adrenal tumors 2018. Endocr Relat Cancer. 2018;25(7):R405\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAwad A, Salem S, Alshoeiby MH, Ahmed BM, Sayed MM. Primary Adrenal Tumors in Adults Single Institute 10 Years \u0026rsquo;. J Trop Dis. 2019;7(4).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThompson LH, Nordenstr\u0026ouml;m E, Almquist M, Jacobsson H, Bergenfelz A. Risk factors for complications after adrenalectomy: results from a comprehensive national database. Langenbecks Arch Surg. 2017;402:315\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJarolim L, Breza J, Wunderlich H. Adrenal tumours. Eur Urol. 2003;43(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eElsaify ERWEA. Surgery Research and Practice 10 Years of Experience of a Single Surgeon in Adrenalectomy: Retrospective Review. Int J Surg Res Pr. 2021;8(2):1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAporowicz M, Domosławski P, Czopnik P, Sutkowski K, Kaliszewski K. Perioperative complications of adrenalectomy \u0026ndash; 12 years of experience from a single center / teaching hospital and literature review. Arch Med Sci. 2018;14(5):1010\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePedull\u0026agrave; G, Sapienza P, Paliotta A, Giordano A, Crocetti D, De Toma G. Surgical considerations for removal of giant tumor of the right adrenal. Anticancer Res. 2014;34(9):5087\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang HS, Li CC, Chou YH, Wang CJ, Wu WJ, Huang CH. Comparison of Laparoscopic Adrenalectomy with Open Surgery for Adrenal Tumors. Kaohsiung J Med Sci. 2009;25(8):438\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Large adrenal tumors, open adrenalectomies","lastPublishedDoi":"10.21203/rs.3.rs-7580783/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7580783/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction: Large adrenal tumors (\u0026gt;\u0026thinsp;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.\u003c/p\u003e\u003cp\u003ePatients and Methods: This was a retrospective review of open adrenalectomies for large adrenal tumors(\u0026gt;\u0026thinsp;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.\u003c/p\u003e\u003cp\u003eResults: A total of 10 patients were reviewed with a mean age of 27\u0026thinsp;\u0026plusmn;\u0026thinsp;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.\u003c/p\u003e\u003cp\u003eConclusion: Open Adrenalectomy for large adrenal tumors using the anterior transperitoneal approach is acceptable with minimal complications in our series.\u003c/p\u003e","manuscriptTitle":"Outcomes of Open Adrenalectomies for Large Adrenal Masses: A case series from a Single-Center Experience","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-24 06:20:48","doi":"10.21203/rs.3.rs-7580783/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"31b1e1a1-3bf4-4557-ad48-cd1620285ced","owner":[],"postedDate":"September 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-22T11:42:01+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-24 06:20:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7580783","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7580783","identity":"rs-7580783","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}