A nationwide study evaluating indications and outcomes for adrenalectomy in children in the Netherlands

BACKGROUND: Adrenal tumors are rare in children, with neuroblastoma being most common. Surgery is the preferred treatment option, using either an open or minimally invasive approach. In this study we evaluated the incidence, spread, and perioperative outcomes of adrenalectomies in children in the Netherlands.

METHODS: Patients treated between 2011 and 2022 were reviewed in this nationwide study across 5 academic hospitals and the national pediatric oncology center. Patient characteristics, perioperative data, and follow-up data were collected.

RESULTS: The epidemiologic data of 187 patients and the clinical data of 137 patients were included. Annually, 18-20 adrenalectomies in children are performed, mostly for neuroblastoma (64%), pheochromocytoma (18%), and adrenocortical carcinoma (6%). Open adrenalectomy was performed in 88 patients (64%), transperitoneal laparoscopic adrenalectomy in 39 patients (29%), and posterior retroperitoneoscopic adrenalectomy in 10 patients (7%). There was a significant difference in duration of surgery between these approaches (median 171 minutes [interquartile range, 120-213], 105 minutes [interquartile range, 85-148], and 67 minutes [interquartile range, 53-101], respectively, P < .001). Minimally invasive adrenalectomy was used more frequently in older patients with presumed benign disease. Perioperative complications occurred in 25 patients (18%), and 36 patients (26%) had a postoperative complication, of which 3 were major. Disease recurrence was observed in 32% of patients.

CONCLUSION: Adrenalectomies in children are rare in the Netherlands, especially for non-neuroblastoma tumors, and most surgeons perform less than 1 procedure per year. Open adrenalectomy is usually performed for suspected malignant tumors, whereas minimally invasive approaches are used more selectively.