Laparoscopic resection of adrenal cortical carcinoma: A cautionary note

While laparoscopic removal of small, benign, functioning adrenal tumors is accepted, laparoscopic resection of adrenal tumors that may be adrenal cortical carcinoma (ACC) remains controversial. The records of all patients with ACC evaluated at a single institution from 1991 through 2004 were reviewe...

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Bibliographic Details
Published in:Surgery 2005-12, Vol.138 (6), p.1078-1086
Main Authors: Gonzalez, Ricardo J., Shapiro, Suzanne, Sarlis, Nicholas, Vassilopoulou-Sellin, Rena, Perrier, Nancy D., Evans, Douglas B., Lee, Jeffrey E.
Format: Article
Language:English
Subjects:
Adolescent
Adrenal Cortex Neoplasms - mortality
Adrenal Cortex Neoplasms - pathology
Adrenal Cortex Neoplasms - surgery
Adrenalectomy
Adult
Aged
Carcinoma - mortality
Carcinoma - pathology
Carcinoma - surgery
Child
Child, Preschool
Female
Follow-Up Studies
Humans
Laparoscopy
Male
Middle Aged
Neoplasm Recurrence, Local - epidemiology
Neoplasm Recurrence, Local - mortality
Neoplasm Recurrence, Local - pathology
Retrospective Studies
Survival Rate
Treatment Outcome
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Summary:While laparoscopic removal of small, benign, functioning adrenal tumors is accepted, laparoscopic resection of adrenal tumors that may be adrenal cortical carcinoma (ACC) remains controversial. The records of all patients with ACC evaluated at a single institution from 1991 through 2004 were reviewed retrospectively. Among 170 patients with ACC, 153 patients underwent open anterior adrenalectomy, 6 underwent laparoscopic adrenalectomy, 1 was treated via an open flank approach, and 10 had no operation. At a median follow-up of 28 months, 115 (86%) of 133 patients who had undergone open anterior resection of primary ACC had had a recurrence. Local recurrence and peritoneal carcinomatosis were components of initial failure in 46 (35%) and 11 patients (8%), respectively. In contrast, all 6 patients who underwent laparoscopic resection of ACC had recurrences, and peritoneal carcinomatosis was a component of initial failure in 5 (83%) of them (open vs laparoscopic resection, Fisher exact test P = .0001). Laparoscopic resection of ACC is associated with a high risk of peritoneal carcinomatosis. Open adrenalectomy remains the standard of care for patients presenting with an adrenal cortical tumor for which ACC is in the differential diagnosis.
ISSN:0039-6060
1532-7361
DOI:10.1016/j.surg.2005.09.012