Comparative Perioperative and Oncologic Outcomes of Open, Laparoscopic, and Robotic Adrenalectomy: A Single-Surgeon Experience from a Tertiary Cancer Center

<title>Abstract</title> <p> <bold>Background:</bold> Adrenalectomy is performed for a broad range of benign and malignant adrenal lesions. Although minimally invasive adrenalectomy has become the preferred approach for most adrenal tumors, comparative data on open, laparoscopic, and robotic adrenalectomy within a single-surgeon practice remain limited. <bold>Methods:</bold> We conducted a retrospective cohort study of adult patients who underwent adrenalectomy at a tertiary cancer center between January 2012 and January 2026. All procedures were performed by a single experienced surgical oncologist. Perioperative, postoperative, and long-term outcomes were compared across open, laparoscopic, and robotic approaches. Multivariable logistic regression was used to identify factors independently associated with surgical approach selection and postoperative Intensive Care Unit (ICU) admission. <bold>Results:</bold> A total of 139 patients underwent adrenalectomy, with a mean age of 44.3 ± 13.4 years; 64.0% were female. Minimally invasive adrenalectomy was performed in 119 patients (85.6%), including 95 laparoscopic (68.3%) and 24 robotic (17.3%) procedures, while 20 patients (14.4%) underwent open adrenalectomy. Open surgery was more frequently used for larger tumors and malignant lesions (both p &lt; 0.01). On multivariable analysis, larger tumors (OR 0.69, 95% CI 0.56–0.84; p &lt; 0.001) and malignancy (OR 0.13, 95% CI 0.03–0.58; p = 0.008) were independently associated with lower odds of a minimally invasive approach. The overall postoperative complication rate was 15.8%, with low rates of 30-day readmission (1.4%) and emergency department visits (3.6%). <bold>Conclusion:</bold> Minimally invasive adrenalectomy was associated with favorable perioperative outcomes and was the predominant approach in this single-surgeon cohort. Tumor size and malignancy were the main factors associated with selection of surgical approach, while open adrenalectomy remained important for large or invasive tumors. the Institutional Review Board (IRB) (Approval No.: SUR0363). </p>