Journal of Gastrointestinal Surgery

, Volume 21, Issue 2, pp 352–362 | Cite as

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
  • John C. Mansour
  • Quan-Yang Duh
  • Natalie Seiser
  • Carmen C. Solorzano
  • Colleen M. Kiernan
  • Konstantinos I. Votanopoulos
  • Edward A. Levine
  • Sharon M. Weber
Original Article

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.

Keywords

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

Notes

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.

Compliance with Ethical Standards

Disclosures and Funding Sources

None.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2016

Authors and Affiliations

  • Christina W. Lee
    • 1
  • Ahmed I. Salem
    • 1
  • David F. Schneider
    • 1
  • Glen E. Leverson
    • 1
  • Thuy B. Tran
    • 2
  • George A. Poultsides
    • 2
  • Lauren M. Postlewait
    • 3
  • Shishir K. Maithel
    • 2
  • Tracy S. Wang
    • 4
  • Ioannis Hatzaras
    • 5
  • Rivfka Shenoy
    • 5
  • John E. Phay
    • 6
  • Lawrence Shirley
    • 6
  • Ryan C. Fields
    • 7
  • Linda X. Jin
    • 7
  • Timothy M. Pawlik
    • 8
  • Jason D. Prescott
    • 8
  • Jason K. Sicklick
    • 9
  • Shady Gad
    • 9
  • Adam C. Yopp
    • 10
  • John C. Mansour
    • 10
  • Quan-Yang Duh
    • 11
  • Natalie Seiser
    • 11
  • Carmen C. Solorzano
    • 12
  • Colleen M. Kiernan
    • 12
  • Konstantinos I. Votanopoulos
    • 13
  • Edward A. Levine
    • 13
  • Sharon M. Weber
    • 1
  1. 1.Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  2. 2.Department of SurgeryStanford UniversityPalo AltoUSA
  3. 3.Department of SurgeryEmory University School of MedicineAtlantaUSA
  4. 4.Department of SurgeryMedical College of WisconsinMilwaukeeUSA
  5. 5.Department of SurgeryNew York University School of MedicineNew YorkUSA
  6. 6.Department of SurgeryOhio State UniversityColumbusUSA
  7. 7.Department of SurgeryWashington UniversitySt. LouisUSA
  8. 8.Department of SurgeryJohns Hopkins University School of MedicineBaltimoreUSA
  9. 9.Department of SurgeryUniversity of CaliforniaSan DiegoUSA
  10. 10.Department of SurgeryUniversity of Texas Southwestern Medical CenterDallasUSA
  11. 11.Department of SurgeryUniversity of CaliforniaSan FranciscoUSA
  12. 12.Department of SurgeryVanderbilt University Medical CenterNashvilleUSA
  13. 13.Department of SurgeryWake Forest University School of MedicineWinston-SalemUSA

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