Journal Article

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

Pawlik, Timothy M., Duh, Quan-Yang, Shenoy, Rivfka, Tran, Thuy B., Leverson, Glen E., Solorzano, Carmen C., Weber, Sharon M., Schneider, David F., Poultsides, George A., Hatzaras, Ioannis, Phay, John E., Lee, Christina W., Mansour, John C., Sicklick, Jason K., Prescott, Jason D., Shirley, Lawrence, Levine, Edward A., Seiser, Natalie, Jin, Linda X., Gad, Shady, Salem, Ahmed I., Fields, Ryan C., Kiernan, Colleen M., Maithel, Shishir K., Wang, Tracy S., Yopp, Adam C., Postlewait, Lauren M., Votanopoulos, Konstantinos I.

2017

Overview

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.

• Publisher: Springer US,Springer Nature B.V
• Subject: Adrenal Cortex Neoplasms - mortality / Adrenal Cortex Neoplasms - pathology / Adrenal Cortex Neoplasms - surgery / Adrenalectomy / Adrenocortical Carcinoma - mortality / Adrenocortical Carcinoma - pathology / Adrenocortical Carcinoma - surgery / Adult / Aged / Aged, 80 and over / Cancer / Disease-Free Survival / Female / Gastroenterology / Humans / Laparoscopy / Lymphatic system / Male / Medical prognosis / Medicine / Medicine & Public Health / Middle Aged / Minimally Invasive Surgical Procedures / Original Article / Prognosis / Retrospective Studies / Surgeons / Surgery / Survival Rate / Young Adult