Laparoscopic resection of adrenal cortical carcinoma: a cautionary note. Surgery 2005 Dec;138(6):1078-85; discussion 1085-6
Date
12/20/2005Pubmed ID
16360394DOI
10.1016/j.surg.2005.09.012Scopus ID
2-s2.0-29144439154 (requires institutional sign-in at Scopus site) 192 CitationsAbstract
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.
Author List
Gonzalez RJ, Shapiro S, Sarlis N, Vassilopoulou-Sellin R, Perrier ND, Evans DB, Lee JEAuthor
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdrenal Cortex Neoplasms
Adrenalectomy
Adult
Aged
Carcinoma
Child
Child, Preschool
Female
Follow-Up Studies
Humans
Laparoscopy
Male
Middle Aged
Neoplasm Recurrence, Local
Retrospective Studies
Survival Rate
Treatment Outcome