engleski

Laparoscopic treatment of adrenocortical carcinoma: Single center experience

Introduction & Objectives: Adrenocortical Carcinoma (ACC) is a rare malignancy with an unfavorable prognosis. Open Adrenalectomy (OA) is the gold standard, but there are reports of non- inferiorty for Laparoscopic Adrenalectomy (LA) if performed by an expert, high-volume surgeon. The aim of this study is to present a single center experience in laparoscopic treatment of ACC. Materials & Methods: This is a retrospective study of all ACC patients treated at The National Referral Center for Adrenal Tumors, where we performed >1000 adrenalectomies in the last 20 years. We report basic demographic data and compare outcomes for open/laparoscopic surgery and expert/non expert surgeon. The results are presented using descriptive statistics, survival analysis was performed using Kaplan-Meier method and the differences tested accordingly. The study was approved by institutional Ethical Committee. Results: In the period from 2010 to 2020, there were 65 ACC patients treated at our institution. We excluded 15 that were European Network for the Study of Adrenal Tumors IV stage and 50 were included in the final analysis: stage I - 6 patients (12%), stage II – 29 patients (58%) and stage III -15 patients (30%), all patients were R0 resection status. There were 16 male and 34 female patients, the median age was 48 years (IQR 39-60). The median tumor size was 95 mm (IQR 74-120) and 21 tumors (42%) were incidentalomas. The median follow-up was 51 months (IQR 32-103). Thirty six patients were treated by an expert surgeon in our center, in that group 7 had recurrence (19%), while fourteen patients were treated by surgeons outside our center, of which 6 (43%) had recurrence, but this was not statistically significant (p=0.09). Disease specific survival (DSS) is better if the surgery is performed by an expert surgeon, as shown in the DSS graph. There were 25 (50%) laparoscopic and 25 (50%) open adrenalectomies, patients in OA group had larger tumors (OA 120mm (IQR 100-140) vs. LA 75 mm (IQR 49-91), p<0.001), no differences were found in recurrence free survival (OA mean 129 months vs. LA mean 109 months, p=0.556) and overall survival (OA mean 149 months vs. LA mean 109 months, p=0.767) between the two groups. Conclusions: This study corroborates the thesis that laparoscopic adrenalectomy for ACC is oncologically safe in the hands of an expert laparoscopic surgeon. Given the low incidence of ACC, these tumors should be treated at expert multidisciplinary referral centers.

laparoscopic treatment ; adrenocortical carcinoma

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