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J Gastrointest Surg. 2017 Feb;21(2):352-362. doi: 10.1007/s11605-016-3262-4. Epub 2016 Oct 21.

Minimally Invasive Resection of Adrenocortical Carcinoma: a Multi-Institutional Study of 201 Patients.

Author information

1
Department of Surgery, University of Wisconsin School of Medicine and Public Health, H4/730 Clinical Science Center, Madison, WI, 53792, USA.
2
Department of Surgery, Stanford University, Palo Alto, CA, USA.
3
Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
4
Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
5
Department of Surgery, New York University School of Medicine, New York, NY, USA.
6
Department of Surgery, Ohio State University, Columbus, OH, USA.
7
Department of Surgery, Washington University, St. Louis, MO, USA.
8
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
9
Department of Surgery, University of California, San Diego, CA, USA.
10
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
11
Department of Surgery, University of California, San Francisco, CA, USA.
12
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
13
Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
14
Department of Surgery, University of Wisconsin School of Medicine and Public Health, H4/730 Clinical Science Center, Madison, WI, 53792, USA. webers@surgery.wisc.edu.

Abstract

BACKGROUND AND OBJECTIVES:

Minimally invasive surgery for adrenocortical carcinoma (ACC) is controversial. We sought to evaluate the perioperative and long-term outcomes following minimally invasive (MIS) and open resection (OA) of ACC in patients treated with curative intent surgery.

METHODS:

Retrospective data from patients who underwent adrenalectomy for primary ACC at 13 tertiary care cancer centers were analyzed, including demographics, clinicopathological, and operative outcomes. Outcomes following MIS were compared to OA.

RESULTS:

A total of 201 patients were evaluated including 47 MIS and 154 OA. There was no difference in utilization of MIS approach among institutions (p = 0.24) or 30-day morbidity (29.3 %, MIS, vs. 30.9 %, OA; p = 0.839). The only preoperatively determined predictor for MIS was smaller tumor size (p < 0.001). There was no difference in rates of intraoperative tumor rupture (p = 0.612) or R0 resection (p = 0.953). Only EBL (p = 0.038) and T stage (p = 0.045) were independent prognostic indicators of overall survival after adjusting for significant factors. The surgical approach was not associated with overall or disease-free survival.

CONCLUSION:

MIS adrenalectomy may be utilized for preoperatively determined ACC ≤ 10.0 cm; however, OA should be utilized for adrenal masses with either preoperative or intraoperative evidence of local invasion or enlarged lymph nodes, regardless of size.

KEYWORDS:

Adrenocortical carcinoma; Disease-free survival; Minimally invasive surgery; Surgical approach; Survival

PMID:
27770290
PMCID:
PMC5263186
DOI:
10.1007/s11605-016-3262-4
[Indexed for MEDLINE]
Free PMC Article

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