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Posterior retroperitoneoscopic adrenalectomy (PRA) in adrenocortical carcinoma (ACC)
Pier Francesco Alesina1,2, Polina Knyazeva3,4, Martin K Walz5
1Department of Medicine, Universität Witten-Herdecke, Witten, Germany. p.alesina@kem-med.com.
Introduction:
Investigating the role of posterior retroperitoneoscopic adrenalectomy (PRA) for the treatment of adrenocortical cancer (ACC).
Methods:
Between January 2010 and December 2024, 28 patients (9 men, 19 female) with am mean age of 51.5 ± 19.5 years (range: 1.6-82.3) underwent PRA for primary ACC. Tumor sizes ranged between 3 and 15 cm (mean: 7.3 cm). Hormonal hypersecretion was found in 12 patients. Surgeries were performed in a standardized 3-port technique in prone position. Follow-up (mean: 37.9 months) data could be obtained for 26 patients.
Results:
There were 12 right and 16 left adrenalectomies. The mean operating time was 159.2 ± 100.9 min (range: 35-340 min). Seven conversions occurred (25%): five to an open approach and two to a laparoscopic approach. One patient with Cushing's syndrome died because of multiple organ failure in the postoperative period (4%). The mean follow-up time was 38.8 ± 35.3 months. Patients with stage I disease demonstrated a 5-year overall survival rate of 100%, whereas patients with stage II and III disease had 3-years survival rates of 64% and 50%, respectively.
Conclusions:
The posterior retroperitoneoscopic approach appears feasible in patient with confirmed or suspected ACC and can be proposed in selected cases.
