Abstract
BACKGROUND: The safety and efficacy of minimally invasive adrenalectomy (MIA) for large pheochromocytoma (PHEO) remains a hotly debated topic. This study aims to shed light on the feasibility and safety of MIA for PHEOs > 5 cm. MATERIALS AND METHODS: We conducted a comprehensive retrospective analysis of 135 patients who underwent MIA for PHEOs at our centre from January 2016 to February 2023. After propensity score-matching (PSM) to balance baseline variables, 91 patients with tumours ≤ 5 cm and 44 patients with tumours > 5 cm were grouped into 33 pairs. Patient demographics and perioperative data were meticulously recorded and compared. RESULTS: After PSM, 33 pairs of patients were included (the larger group: 13 males, 20 females; mean age 50.0 ± 14.8 years; the smaller group: 12 males, 21 females; mean age 53.7 ± 11.8 years). There was no significant difference in baseline characteristics between the two groups except for tumour size (6.4 vs. 3.4 cm, p < 0.001). The larger group had longer operative time (130 vs. 95 min, p = 0.020) and drainage tube removal time (4.0 vs. 3.0 days, p = 0.005). However, no significant differences were observed in intraoperative hemodynamic outcomes, transfusion rate and perioperative complications. Logistic regression analysis revealed that hypertension was an independent risk factor for hemodynamic instability (OR = 6.681, 95% CI: 1.270-35.148, p = 0.025). CONCLUSIONS: Although MIA for PHEOs > 5 cm had longer operative time and drainage tube removal time, it did not affect intraoperative hemodynamic outcomes and perioperative complications. Thus, minimally invasive adrenalectomy represents a viable and effective surgical option for managing large PHEO.