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Surgery. 2005 Dec;138(6):1078-85; discussion 1085-6.

Laparoscopic resection of adrenal cortical carcinoma: a cautionary note.

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1
Department of Surgical Oncology, The University of Texas M.D. Anderso Cancer Center, Houston, TX 77030-4009, USA.

Abstract

BACKGROUND:

While laparoscopic removal of small, benign, functioning adrenal tumors is accepted, laparoscopic resection of adrenal tumors that may be adrenal cortical carcinoma (ACC) remains controversial.

METHODS:

The records of all patients with ACC evaluated at a single institution from 1991 through 2004 were reviewed retrospectively.

RESULTS:

Among 170 patients with ACC, 153 patients underwent open anterior adrenalectomy, 6 underwent laparoscopic adrenalectomy, 1 was treated via an open flank approach, and 10 had no operation. At a median follow-up of 28 months, 115 (86%) of 133 patients who had undergone open anterior resection of primary ACC had had a recurrence. Local recurrence and peritoneal carcinomatosis were components of initial failure in 46 (35%) and 11 patients (8%), respectively. In contrast, all 6 patients who underwent laparoscopic resection of ACC had recurrences, and peritoneal carcinomatosis was a component of initial failure in 5 (83%) of them (open vs laparoscopic resection, Fisher exact test P = .0001).

CONCLUSIONS:

Laparoscopic resection of ACC is associated with a high risk of peritoneal carcinomatosis. Open adrenalectomy remains the standard of care for patients presenting with an adrenal cortical tumor for which ACC is in the differential diagnosis.

PMID:
16360394
DOI:
10.1016/j.surg.2005.09.012
[Indexed for MEDLINE]
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