Does Laparoscopic Adrenalectomy Jeopardize Oncologic Outcomes for Patients with Known or Suspected Adrenocortical Carcinoma?

Amanda Cooper, MD, Mouhammed Habra, MD, Elizabeth Grubbs, MD, Brian Bednarski, Anita Ying, MD, Alexandria Phan, MD, Nancy Perrier, MD, Jeffrey Lee, MD, Thomas Aloia, MD

The University of Texas M.D. Anderson Cancer Center

Introduction: For patients with known or suspected adrenocortical carcinoma (ACC), considerable controversy exists over the use of laparoscopic adrenalectomy. The purpose of this project was to assess recurrence patterns in patients with a pathologic diagnosis of ACC treated with laparoscopic versus open adrenalectomy.

Methods and Procedures: All patients referred to our center with a diagnosis of ACC from April 1, 1993 to May 1, 2012 were reviewed. Three groups of patients were compared: those referred after open resection elsewhere, those referred after laparoscopic resection elsewhere, and those treated primarily at our center (all resected by open approach). Overall survivals were compared between groups using Kaplan-Meier curves.

Results: During the study period, 46 patients presented after laparoscopic resection at an outside institution, 215 patients after open resection at an outside institution, and 45 patients were treated at our institution with open resection. For the laparoscopic group, median pathologic tumor size was 8.0 cm (range 1-15 cm) vs. 12.0 cm (3.5-16 cm) for the open at outside institution group and 12.0 cm (4-30 cm) for the group resected at our institution (p=0.002). In the laparoscopic group, 52.2% of patients developed a peritoneal recurrence at a median time of 9.9 months, compared to 27.4% at a mean time of 14.2 months in the open at outside institution group and 20.0% at a mean time of 14.4 months in the open at our institution group (p=0.002 for % peritoneal recurrence, Figure). Peritoneal recurrence after laparoscopic resection was salvageable with subsequent surgery in only 8.3% of patients versus 18.6% in the open group.

Conclusion: Despite typically being performed in patients with smaller tumors, laparoscopic adrenalectomy for ACC is associated with higher rates of peritoneal recurrence. For patients with known or suspected ACC, the oncologic benefits of open resection outweigh the short-term benefits of minimally invasive surgery.