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

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

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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Author Contribution

Each author listed in the following manuscript contributed significantly to the concept and/or design of this work in the form of data acquisition, analysis, and interpretation of results. Each author was involved in the drafting or revision of the intellectual content included in this manuscript and provided final approval of the current version. All authors agree to be accountable for the following work.

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Authors and Affiliations

  1. Department of Surgery, University of Wisconsin School of Medicine and Public Health, H4/730 Clinical Science Center, Madison, WI, 53792, USA

    Christina W. Lee, Ahmed I. Salem, David F. Schneider, Glen E. Leverson & Sharon M. Weber

  2. Department of Surgery, Stanford University, Palo Alto, CA, USA

    Thuy B. Tran, George A. Poultsides & Shishir K. Maithel

  3. Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Lauren M. Postlewait

  4. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Tracy S. Wang

  5. Department of Surgery, New York University School of Medicine, New York, NY, USA

    Ioannis Hatzaras & Rivfka Shenoy

  6. Department of Surgery, Ohio State University, Columbus, OH, USA

    John E. Phay & Lawrence Shirley

  7. Department of Surgery, Washington University, St. Louis, MO, USA

    Ryan C. Fields & Linda X. Jin

  8. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Timothy M. Pawlik & Jason D. Prescott

  9. Department of Surgery, University of California, San Diego, CA, USA

    Jason K. Sicklick & Shady Gad

  10. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Adam C. Yopp & John C. Mansour

  11. Department of Surgery, University of California, San Francisco, CA, USA

    Quan-Yang Duh & Natalie Seiser

  12. Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Carmen C. Solorzano & Colleen M. Kiernan

  13. Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Konstantinos I. Votanopoulos & Edward A. Levine

Authors
  1. Christina W. Lee
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  2. Ahmed I. Salem
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  3. David F. Schneider
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  4. Glen E. Leverson
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  5. Thuy B. Tran
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  6. George A. Poultsides
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  7. Lauren M. Postlewait
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  8. Shishir K. Maithel
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  9. Tracy S. Wang
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  10. Ioannis Hatzaras
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  11. Rivfka Shenoy
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  12. John E. Phay
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  13. Lawrence Shirley
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  14. Ryan C. Fields
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  15. Linda X. Jin
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  16. Timothy M. Pawlik
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  17. Jason D. Prescott
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  18. Jason K. Sicklick
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  19. Shady Gad
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  20. Adam C. Yopp
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  21. John C. Mansour
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  22. Quan-Yang Duh
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  23. Natalie Seiser
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  24. Carmen C. Solorzano
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  25. Colleen M. Kiernan
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  26. Konstantinos I. Votanopoulos
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  27. Edward A. Levine
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  28. Sharon M. Weber
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Corresponding author

Correspondence to Sharon M. Weber.

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Lee, C.W., Salem, A.I., Schneider, D.F. et al. Minimally Invasive Resection of Adrenocortical Carcinoma: a Multi-Institutional Study of 201 Patients. J Gastrointest Surg 21, 352–362 (2017). https://doi.org/10.1007/s11605-016-3262-4

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  • DOI: https://doi.org/10.1007/s11605-016-3262-4

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