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A Novel Method: Super-selective Adrenal Venous Sampling
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Minimally Invasive Surgery for Resectable Adrenocortical Carcinoma: A Nationwide Analysis.

Aaron M Delman1, Kevin M Turner1, Azante Griffith2

  • 1Department of Surgery, University of Cincinnati, Cincinnati, Ohio; Cincinnati Research on Outcomes and Safety in Surgery (CROSS) Research Group, University of Cincinnati, Cincinnati, Ohio.

The Journal of Surgical Research
|July 3, 2022
PubMed
Summary

Minimally invasive surgery (MIS) for adrenocortical carcinoma (ACC) is safe and does not worsen survival outcomes. MIS is recommended for adrenal masses, even large ones, improving survival in appropriately selected patients.

Keywords:
Adrenal tumorsAdrenocortical carcinomaGuidelines adrenocortical carcinomaLaparoscopic resectionMinimally invasive surgeryRobotic resection

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Area of Science:

  • Surgical Oncology
  • Adrenocortical Carcinoma Research
  • Minimally Invasive Surgical Techniques

Background:

  • Adrenocortical carcinoma (ACC) surgical resection guidelines favor open approaches due to oncologic concerns.
  • Minimally invasive surgery (MIS) adoption for ACC is increasing despite controversy.
  • Current evidence on MIS for ACC survival outcomes is limited.

Purpose of the Study:

  • To evaluate the association between MIS utilization and survival in ACC patients.
  • To compare oncologic outcomes and overall survival between MIS and open resection for ACC.
  • To determine if MIS is a safe alternative for ACC resection regardless of tumor size.

Main Methods:

  • Analysis of the National Cancer Database (2010-2017) for ACC surgical resections.
  • Comparison of patient selection, oncologic outcomes, and survival between MIS (laparoscopic/robotic) and open approaches.
  • Univariable and multivariable survival analyses were performed.

Main Results:

  • MIS utilization for ACC increased significantly post-2013.
  • No difference in overall survival between MIS and open resections on univariable analysis.
  • Multivariable analysis showed improved survival with MIS (HR 0.83).
  • Survival was comparable for large (6-10 cm) and giant (>10 cm) ACCs regardless of approach.

Conclusions:

  • MIS can be safely performed in appropriately selected ACC patients without compromising survival.
  • MIS is a viable option for adrenal masses, including those larger than 6 cm.
  • Consideration of MIS for ACC resection is recommended, irrespective of tumor size.