Impact of Laparoscopic Adrenalectomy on Overall Survival in Patients with Non-Metastatic Adrenocortical Carcinoma

Appropriate use of laparoscopic adrenalectomy (LA) for adrenocortical carcinoma (ACC) remains controversial since complete resection with negative margins is the best chance for potential cure. This study compares the oncologic outcomes and overall survival (OS) of LA and open adrenalectomy (OA) for ACC.

A retrospective analysis of the National Cancer Data Base (NCDB) between 2010-2014 identified 423 European Network for the Study of Adrenal Tumors (ENSAT) stage I-III ACC patients that had LA (n=137) or OA (n=286). Outcomes and OS were compared between the two groups.

Patients who underwent OA had more advanced stage disease (p=0.0001), larger (≥ 5 cm) tumors (p<0.0001), and were younger (age <55, p=0.05). Nodal assessment was rare in LA (n=4) compared to OA (n=88) (p<0.0001). Margin positivity was only affected by surgical approach in patients with T3 tumors (LA 54.6% vs. OA 21.7%; p=0.0009). Neither surgical procedure nor any socio-demographic factor(s) impacted OS for the entire cohort. Only positive margins (p=0.007), positive nodes (p=0.02), tumor extension (p=0.01) and more advanced ENSAT stage (p=0.004) increased mortality. When stratified by disease stage, LA decreased OS for patients with stage II disease (p=0.04), and remained an independent risk factor for death on multivariate analysis (HR 1.86, 95% CI 1.02-3.38; p=0.04). Only positive margins decreased OS in the entire cohort (HR: 2.17, 95% CI 1.32-3.57; p=0.002).

Use of LA may decrease OS in select patients with ACC. Since margin status remains the strongest predictor of mortality, caution should be used in selecting LA for ACC.

Journal of the American College of Surgeons. 2016 May 26 [Epub ahead of print]

Kelly T Huynh, David Y Lee, Briana J Lau, Devin C Flaherty, JiHey Lee, Melanie Goldfarb

Department of Surgical Oncology, John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA., Department of Surgical Oncology, John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA., Department of Surgical Oncology, John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA., Department of Surgical Oncology, John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA., Department of Biostatistics, John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA., Department of Surgical Oncology, John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA. Electronic address: .

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