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. YoppJohn C. Mansour, Quan Yang Duh, Natalie Seiser, Carmen C. Solorzano, Colleen M. Kiernan, Konstantinos I. Votanopoulos, Edward A. Levine, Sharon M. Weber

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)352-362
Number of pages11
JournalJournal of Gastrointestinal Surgery
Volume21
Issue number2
DOIs
StatePublished - Feb 1 2017

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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