Obesity is an increasingly common disease worldwide.1 Patients with obesity are usually at higher risk of intraoperative and postoperative complications due to the greater difficulty of anesthetic management, higher rate of conversion to open surgery, and higher number of surgical wound infections among others.2

Adrenalectomy can be performed by different approaches (open, laparoscopic, or robot-assisted). Today, laparoscopic adrenalectomy is considered the first-line treatment for most adrenal tumors.3 It has been demonstrated that laparoscopy compared with open adrenalectomy has a lower risk of intraoperative morbidity, shorter hospital stays, and fewer postoperative complications.3, 4 Nevertheless, open adrenalectomy is still the technique of choice in patients with large tumors or with signs of infiltration of adjacent tissues.4 The rise in the number of obese patients in recent years, has increased the difficulty of the surgical technique, with a higher rate of conversion to open surgery in laparoscopic adrenalectomy (1–22%).5 Some other studies have examined the results of laparoscopic adrenalectomy in obese and non-obese patients.6 However, most of these studies are retrospective, the number of patients included is usually low, and they do not distinguish whether the indication of surgery was for a primary tumor or for metastasis, taking into account that patients with a previous oncological history tend to have a lower weight than patients with a primary adrenal tumor. To overcome these limitations, we have included all consecutive patients with adrenal tumors operated on in our center, but we have excluded those patients with metastatic tumors in the adrenal gland.

The aim of our study is to evaluate the impact of obesity on surgical outcomes in adrenal gland surgery in a large cohort of patients who underwent adrenalectomy due to benign or malignant primary adrenal disease.