Background: The suitability of minimally invasive adrenalectomy (MIA) for adrenal tumors ≥6 cm remains debated due to technical challenges and oncological concerns. This study aimed to assess the safety and feasibility of MIA for large adrenal tumors by comparing surgical outcomes with smaller tumors. Methods: This retrospective cohort study included 269 patients who underwent MIA (2013–2023), divided into two groups: Group A (<6 cm, n = 197) and Group B (≥6 cm, n = 72). The primary endpoint was the postoperative complication rate; secondary endpoints included conversion to open surgery and postoperative length of stay (LOS). Results: Multivariate analysis identified no factors associated with postoperative complications; however, tumor size ≥ 6 cm was associated with conversion to open surgery (p = 0.031). Bilateral procedures and a higher Charlson comorbidity index were associated with longer LOS (p < 0.001 and p = 0.015, respectively). Conclusions: MIA is a safe and feasible approach for tumors ≥6 cm, despite being associated with a higher conversion rate.

Background: The suitability of minimally invasive adrenalectomy (MIA) for adrenal tumors ≥6 cm remains debated due to technical challenges and oncological concerns. This study aimed to assess the safety and feasibility of MIA for large adrenal tumors by comparing surgical outcomes with smaller tumors. Methods: This retrospective cohort study included 269 patients who underwent MIA (2013–2023), divided into two groups: Group A (< 6 cm, n=197) and Group B (≥6 cm, n=72). The primary endpoint was the postoperative complication rate; secondary endpoints included conversion to open surgery and postoperative length of stay (LOS). Results: Multivariate analysis identified no factors associated with postoperative complications, whereas tumor size ≥6 cm was associated with conversion to open surgery (p=0.031). Bilateral procedures and a higher Charlson comorbidity index were associated with longer LOS (p< 0.001 and p=0.015, respectively). Conclusion: MIA is a safe and feasible approach for tumors ≥6 cm, despite being associated with a higher conversion rate.