Comparative Outcomes of Laparoscopic and Open Adrenalectomy for Adrenocortical Carcinoma: Single, High-Volume Center Experience
- Maria C. Mir MD, PhD,
- Joseph C. Klink MD,
- Julien Guillotreau MD,
- Jean-Alexandre Long MD, PhD,
- Ranko Miocinovic MD,
- Jihad H. Kaouk MD,
- Matthew N. Simmons MD, PhD,
- Eric Klein MD,
- Venkatesh Krishnamurthi MD,
- Steven C. Campbell MD, PhD,
- Amr F. Fergany MD,
- Jordan Reynolds MD,
- Andrew J. Stephenson MD,
- Georges-Pascal Haber MD, PhD
- … show all 14 hide
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Adrenocortical carcinoma (ACC) is a rare and clinically aggressive cancer. Previous studies reported increased recurrence rates associated with laparoscopic adrenalectomy (LA). We evaluated a single-center experience of LA versus open adrenalectomy (OA) for the management of ACC.
Between 1993 and 2011, 44 consecutive patients with primary ACC were treated at our institution. Baseline patient characteristics and surgical and pathological outcomes were compared between OA and LA groups. Multivariable Cox proportional hazards analysis was used to estimate the association between OA versus LA with recurrence-free and overall survival.
Eighteen and 26 patients underwent LA and OA, respectively. Patients who underwent OA had larger tumors and more advanced clinical stage compared with LA group. During a median follow-up of 22 months, 22 recurrences and 26 deaths were observed. The 2-year, recurrence-free and overall survivals for OA and LA were 60 vs. 39 % (P = 0.7) and 54 vs. 58 % (P = 0.6), respectively. After adjusting for clinical stage, OA was associated with lower risk of recurrence (hazard ratio (HR) 0.4; 95 % confidence interval (CI) 0.2–1.2; P = 0.099) and improved overall survival (HR 0.5; 95 % CI 0.2–1.2; P = 0.122) compared with LA, although differences were not statistically significant.
A nonstatistically significant increase in recurrence and death was observed among patients undergoing LA versus OA after adjusting for clinical stage. The rarity of this disease limits the ability to assess for significant differences in a single-institution series. Patients with suspected ACC should be considered for OA.
- Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62(1):10–29. CrossRef
- Bilimoria KY, Shen WT, Elaraj D, Bentrem DJ, Winchester DJ, Kebebew E, et al. Adrenocortical carcinoma in the United States: treatment utilization and prognostic factors. Cancer. 2008;113(11):3130–6. CrossRef
- Prinz RA. A comparison of laparoscopic and open adrenalectomies. Arch Surg. 1995;130(5):489–92; discussion 92–4.
- Thompson GB, Grant CS, van Heerden JA, Schlinkert RT, Young WF, Farley DR, et al. Laparoscopic versus open posterior adrenalectomy: a case-control study of 100 patients. Surgery. 1997;122(6):1132–6. CrossRef
- Lee J, El-Tamer M, Schifftner T, Turrentine FE, Henderson WG, Khuri S, et al. Open and laparoscopic adrenalectomy: analysis of the National Surgical Quality Improvement Program. J Am Coll Surg. 2008;206(5):953–9; discussion 9–61.
- Gumbs AA, Gagner M. Laparoscopic adrenalectomy. Best Pract Res Clin Endocrinol Metab. 2006;20(3):483–99. CrossRef
- Schulick RD, Brennan MF. Long-term survival after complete resection and repeat resection in patients with adrenocortical carcinoma. Ann Surg Oncol. 1999;6(8):719–26. CrossRef
- Suzuki K, Ushiyama T, Ihara H, Kageyama S, Mugiya S, Fujita K. Complications of laparoscopic adrenalectomy in 75 patients treated by the same surgeon. Eur Urol. 1999;36(1):40–7. CrossRef
- Deckers S, Derdelinckx L, Col V, Hamels J, Maiter D. Peritoneal carcinomatosis following laparoscopic resection of an adrenocortical tumor causing primary hyperaldosteronism. Horm Res. 1999;52(2):97–100. CrossRef
- Gonzalez RJ, Shapiro S, Sarlis N, Vassilopoulou-Sellin R, Perrier ND, Evans DB, et al. Laparoscopic resection of adrenal cortical carcinoma: a cautionary note. Surgery. 2005;138(6):1078–85; discussion 85–6.
- Miller BS, Ammori JB, Gauger PG, Broome JT, Hammer GD, Doherty GM. Laparoscopic resection is inappropriate in patients with known or suspected adrenocortical carcinoma. World J Surg. 2010;34(6):1380–5. CrossRef
- Brix D, Allolio B, Fenske W, Agha A, Dralle H, Jurowich C, et al. Laparoscopic versus open adrenalectomy for adrenocortical carcinoma: surgical and oncologic outcome in 152 patients. Eur Urol. 2010;58(4):609–15. CrossRef
- Gill IS, Schweizer D, Hobart MG, Sung GT, Klein EA, Novick AC. Retroperitoneal laparoscopic radical nephrectomy: the Cleveland Clinic experience. J Urol. 2000;163(6):1665–70. CrossRef
- Moinzadeh A, Gill IS. Laparoscopic radical adrenalectomy for malignancy in 31 patients. J Urol. 2005;173(2):519–25. CrossRef
- Guz BV, Straffon RA, Novick AC. Operative approaches to the adrenal gland. Urol Clin North Am. 1989;16(3):527–34.
- Morgan M, Smith N, Thomas K, Murphy DG. Is Clavien the new standard for reporting urological complications? BJU Int. 2009;104(4):434–6. CrossRef
- Weiss LM. Comparative histologic study of 43 metastasizing and nonmetastasizing adrenocortical tumors. Am J Surg Pathol. 1984;8(3):163–9. CrossRef
- Aubert S, Wacrenier A, Leroy X, Devos P, Carnaille B, Proye C, et al. Weiss system revisited: a clinicopathologic and immunohistochemical study of 49 adrenocortical tumors. Am J Surg Pathol. 2002;26(12):1612–9. CrossRef
- van Slooten H, Schaberg A, Smeenk D, Moolenaar AJ. Morphologic characteristics of benign and malignant adrenocortical tumors. Cancer. 1985;55(4):766–73. CrossRef
- Zeiger MA, Thompson GB, Duh QY, Hamrahian AH, Angelos P, Elaraj D, et al. American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Incidentalomas: executive summary of recommendations. Endocr Pract. 2009;15(5):450–3.
- Allolio B, Fassnacht M. Clinical review: Adrenocortical carcinoma: clinical update. J Clin Endocrinol Metab. 2006;91(6):2027–37. CrossRef
- Porpiglia F, Fiori C, Daffara F, Zaggia B, Bollito E, Volante M, et al. Retrospective evaluation of the outcome of open versus laparoscopic adrenalectomy for stage I and II adrenocortical cancer. Eur Urol. 2010;57(5):873–8. CrossRef
- Guerrieri M, De Sanctis A, Crosta F, Arnaldi G, Boscaro M, Lezoche G, et al. Adrenal incidentaloma: surgical update. J Endocrinol Invest. 2007;30(3):200–4.
- Reibetanz J, Jurowich C, Erdogan I, Nies C, Rayes N, Dralle H, et al. Impact of lymphadenectomy on the oncologic outcome of patients with adrenocortical carcinoma. Ann Surg. 2012;255(2):363–9. CrossRef
- Comparative Outcomes of Laparoscopic and Open Adrenalectomy for Adrenocortical Carcinoma: Single, High-Volume Center Experience
Annals of Surgical Oncology
Volume 20, Issue 5 , pp 1456-1461
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Maria C. Mir MD, PhD (1)
- Joseph C. Klink MD (1)
- Julien Guillotreau MD (1)
- Jean-Alexandre Long MD, PhD (1)
- Ranko Miocinovic MD (1)
- Jihad H. Kaouk MD (1)
- Matthew N. Simmons MD, PhD (1)
- Eric Klein MD (1)
- Venkatesh Krishnamurthi MD (1)
- Steven C. Campbell MD, PhD (1)
- Amr F. Fergany MD (1)
- Jordan Reynolds MD (2)
- Andrew J. Stephenson MD (1)
- Georges-Pascal Haber MD, PhD (1)
- Author Affiliations
- 1. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- 2. Pathology Molecular Institute, Cleveland Clinic, Cleveland, OH, USA