TY - JOUR
T1 - Laparoscopic resection of adrenal cortical carcinoma
T2 - A cautionary note
AU - Gonzalez, Ricardo J.
AU - Shapiro, Suzanne
AU - Sarlis, Nicholas
AU - Vassilopoulou-Sellin, Rena
AU - Perrier, Nancy D.
AU - Evans, Douglas B.
AU - Lee, Jeffrey E.
AU - Inabnet, William B.
AU - Libutti, Steven K.
AU - Chen, Herbert
AU - Duh, Quan Yang
AU - Wilhelm, Scott
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2005/12
Y1 - 2005/12
N2 - Background. 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. Methods. The records of all patients with ACC evaluated at a single institution from 1991 through 2004 were reviewed retrospectively. Results. 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). Conclusions. 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.
AB - Background. 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. Methods. The records of all patients with ACC evaluated at a single institution from 1991 through 2004 were reviewed retrospectively. Results. 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). Conclusions. 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.
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U2 - 10.1016/j.surg.2005.09.012
DO - 10.1016/j.surg.2005.09.012
M3 - Article
C2 - 16360394
AN - SCOPUS:29144439154
SN - 0039-6060
VL - 138
SP - 1078
EP - 1086
JO - Surgery
JF - Surgery
IS - 6
ER -