Open vs laparoscopic adrenalectomy for localized adrenocortical carcinoma

Abstract

Objective The purpose of the study was to compare the long‐term outcomes of patients with localized adrenocortical carcinoma (ACC) subjected to open vs laparoscopic surgery. Design Retrospective study. Patients This retrospective study included 46 patients with the ACC ENSAT stage I‐stage III of whom 23 underwent open surgery (OA group), whereas 23 were subjected to laparoscopic adrenalectomy (LA group). The main outcomes analysed in the study were differences between the OA and LA groups in recurrence‐free survival (RFS) and overall survival (OS). Results Patients in OA group had larger tumours (120 [70‐250] mm vs 75 [26‐110] mm; P < .001), higher Ki‐67 index (16 [1‐65] % vs 10 [1‐25] %; P = .04) and higher disease stage (P = .01) compared with the patients in the LA group. The median duration of follow‐up for patients underwent OA and LA was 51 (12‐174) and 53 (5‐127) months, respectively. Eight patients (5 OA and 3 LA) experienced recurrent disease, whereas six patients (3 OA and 3 LA) died during follow‐up. No differences in RFS and OS were found between patients who underwent open or laparoscopic surgery. Conclusion The study demonstrated that in patients with localized ACC and without invasion of extra‐adrenal tissues, LA is a plausible treatment option in terms of RFS and OS. However, our results are limited to referral centres with large experience in the management of patients with ACC and may not necessarily apply to nonspecialized centres.

Surgical Management of Adrenocortical Carcinoma: Current Highlights

“…Patients treated with open adrenalectomy (OA) were more likely to have a larger tumor: median size was from 6.8 to 14 cm for ACC treated by OA, and from 5.5 to 9 cm for tumors treated by mini-invasive surgery. Seven studies showed that LA was effective for ACC when the tumor size is <10 cm and showed no local invasion, enlarged lymph-nodes or distant metastases (ENSAT stage I–II) [ 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. Some authors suggested that LA should be only performed in high volume referral centers.…”

“…Some authors suggested that LA should be only performed in high volume referral centers. Twelve studies reported a total of 89 conversions from MIS to an open approach [ 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. Conversely, eight further studies [ 38 , 46 , 47 , 49 , 50 , 51 , 52 , 53 ] confirmed OA as the standard operative technique for ACC.…”

Surgical Management of Adrenocortical Carcinoma: A Literature Review

“…Considering the ENSAT stage system, three studies included stage I-II patients [ 6 , 7 , 8 ]; six studies included stage I-III patients [ 9 , 10 , 11 , 12 , 13 , 14 ], and five studies included stage I-IV patients [ 15 , 16 , 17 , 18 , 19 ].…”

“…Notwithstanding, several authors suggested favorable oncological outcomes of MIA for ACC [ 6 , 7 , 14 , 17 , 18 ].…”

The Effect of Surgeon Expertise on the Outcome of Patients with Adrenocortical Carcinoma

“…Various factors may contribute to a more favorable ACC treatment outcome in expert centers. Center volume and surgical experience are crucial in this regard [18,19], but other factors, such as optimal post-surgical care, including a standardized follow-up protocol by a multidisciplinary team of experts and adjuvant mitotane treatment, could also play an important role. In the present study, the majority of the patients operated in the LVCs were referred to the HVC within three months after the surgery, and they were subjected to identical follow-up monitoring and treatment protocol as the patients operated on in the HVC.…”