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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2013

01-05-2013 | Endocrine Tumors

Comparative Outcomes of Laparoscopic and Open Adrenalectomy for Adrenocortical Carcinoma: Single, High-Volume Center Experience

Authors: 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

Published in: Annals of Surgical Oncology | Issue 5/2013

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.
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Metadata
Title
Comparative Outcomes of Laparoscopic and Open Adrenalectomy for Adrenocortical Carcinoma: Single, High-Volume Center Experience
Authors
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
Publication date
01-05-2013
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 5/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2760-1

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