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

Christina W. Lee, Ahmed I. Salem, David F. Schneider, Glen E. Leverson, Thuy B. Tran, George A. Poultsides, Lauren M. Postlewait, Shishir K. Maithel, Tracy S. Wang, Ioannis Hatzaras, Rivfka Shenoy, John E. Phay, Lawrence Shirley, Ryan C. Fields, Linda X. Jin, Timothy M. Pawlik, Jason D. Prescott, Jason K. Sicklick, Shady Gad, Adam C. Yopp & 8 others John C. Mansour, Quan Yang Duh, Natalie Seiser, Carmen C. Solorzano, Colleen M. Kiernan, Konstantinos I. Votanopoulos, Edward A. Levine, Sharon M. Weber

Research output: Research - peer-reviewArticle

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.

LanguageEnglish (US)
Pages352-362
Number of pages11
JournalJournal of Gastrointestinal Surgery
Volume21
Issue number2
DOIs
StatePublished - Feb 1 2017

Fingerprint

Adrenocortical Carcinoma
Neoplasms
Adrenalectomy
Minimally Invasive Surgical Procedures
Tertiary Care Centers
Disease-Free Survival
Rupture
Lymph Nodes
Demography
Morbidity
Survival

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Lee, C. W., Salem, A. I., Schneider, D. F., Leverson, G. E., Tran, T. B., Poultsides, G. A., ... Weber, S. M. (2017). Minimally Invasive Resection of Adrenocortical Carcinoma: a Multi-Institutional Study of 201 Patients. Journal of Gastrointestinal Surgery, 21(2), 352-362. DOI: 10.1007/s11605-016-3262-4

Minimally Invasive Resection of Adrenocortical Carcinoma : a Multi-Institutional Study of 201 Patients. / Lee, Christina W.; Salem, Ahmed I.; Schneider, David F.; Leverson, Glen E.; Tran, Thuy B.; Poultsides, George A.; Postlewait, Lauren M.; Maithel, Shishir K.; Wang, Tracy S.; Hatzaras, Ioannis; Shenoy, Rivfka; Phay, John E.; Shirley, Lawrence; Fields, Ryan C.; Jin, Linda X.; Pawlik, Timothy M.; Prescott, Jason D.; Sicklick, Jason K.; Gad, Shady; Yopp, Adam C.; Mansour, John C.; Duh, Quan Yang; Seiser, Natalie; Solorzano, Carmen C.; Kiernan, Colleen M.; Votanopoulos, Konstantinos I.; Levine, Edward A.; Weber, Sharon M.

In: Journal of Gastrointestinal Surgery, Vol. 21, No. 2, 01.02.2017, p. 352-362.

Research output: Research - peer-reviewArticle

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 2017, 'Minimally Invasive Resection of Adrenocortical Carcinoma: a Multi-Institutional Study of 201 Patients' Journal of Gastrointestinal Surgery, vol 21, no. 2, pp. 352-362. DOI: 10.1007/s11605-016-3262-4
Lee CW, Salem AI, Schneider DF, Leverson GE, Tran TB, Poultsides GA et al. Minimally Invasive Resection of Adrenocortical Carcinoma: a Multi-Institutional Study of 201 Patients. Journal of Gastrointestinal Surgery. 2017 Feb 1;21(2):352-362. Available from, DOI: 10.1007/s11605-016-3262-4
Lee, Christina W. ; Salem, Ahmed I. ; Schneider, David F. ; Leverson, Glen E. ; Tran, Thuy B. ; Poultsides, George A. ; Postlewait, Lauren M. ; Maithel, Shishir K. ; Wang, Tracy S. ; Hatzaras, Ioannis ; Shenoy, Rivfka ; Phay, John E. ; Shirley, Lawrence ; Fields, Ryan C. ; Jin, Linda X. ; Pawlik, Timothy M. ; Prescott, Jason D. ; Sicklick, Jason K. ; Gad, Shady ; Yopp, Adam C. ; Mansour, John C. ; Duh, Quan Yang ; Seiser, Natalie ; Solorzano, Carmen C. ; Kiernan, Colleen M. ; Votanopoulos, Konstantinos I. ; Levine, Edward A. ; Weber, Sharon M./ Minimally Invasive Resection of Adrenocortical Carcinoma : a Multi-Institutional Study of 201 Patients. In: Journal of Gastrointestinal Surgery. 2017 ; Vol. 21, No. 2. pp. 352-362
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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.",
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T2 - Journal of Gastrointestinal Surgery

AU - Lee,Christina W.

AU - Salem,Ahmed I.

AU - Schneider,David F.

AU - Leverson,Glen E.

AU - Tran,Thuy B.

AU - Poultsides,George A.

AU - Postlewait,Lauren M.

AU - Maithel,Shishir K.

AU - Wang,Tracy S.

AU - Hatzaras,Ioannis

AU - Shenoy,Rivfka

AU - Phay,John E.

AU - Shirley,Lawrence

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AU - Jin,Linda X.

AU - Pawlik,Timothy M.

AU - Prescott,Jason D.

AU - Sicklick,Jason K.

AU - Gad,Shady

AU - Yopp,Adam C.

AU - Mansour,John C.

AU - Duh,Quan Yang

AU - Seiser,Natalie

AU - Solorzano,Carmen C.

AU - Kiernan,Colleen M.

AU - Votanopoulos,Konstantinos I.

AU - Levine,Edward A.

AU - Weber,Sharon M.

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N2 - 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.

AB - 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.

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KW - Disease-free survival

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KW - Surgical approach

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