Faculty Collaboration Database

Minimally Invasive Resection of Adrenocortical Carcinoma: a Multi-Institutional Study of 201 Patients. J Gastrointest Surg 2017 Feb;21(2):352-362

Date

10/23/2016

Pubmed ID

27770290

Pubmed Central ID

PMC5263186

DOI

10.1007/s11605-016-3262-4

Scopus ID

2-s2.0-84992116155 (requires institutional sign-in at Scopus site)   21 Citations

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.

Author List

Lee CW, Salem AI, Schneider DF, Leverson GE, Tran TB, Poultsides GA, Postlewait LM, Maithel SK, Wang TS, Hatzaras I, Shenoy R, Phay JE, Shirley L, Fields RC, Jin LX, Pawlik TM, Prescott JD, Sicklick JK, Gad S, Yopp AC, Mansour JC, Duh QY, Seiser N, Solorzano CC, Kiernan CM, Votanopoulos KI, Levine EA, Weber SM

Author

Tracy S. Wang MD, MPH Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adrenal Cortex Neoplasms
Adrenalectomy
Adrenocortical Carcinoma
Adult
Aged
Aged, 80 and over
Disease-Free Survival
Female
Humans
Male
Middle Aged
Minimally Invasive Surgical Procedures
Prognosis
Retrospective Studies
Survival Rate
Young Adult