Laparoscopic resection of adrenal cortical carcinoma: A cautionary note

Ricardo J. Gonzalez, Suzanne Shapiro, Nicholas Sarlis, Rena Vassilopoulou-Sellin, Nancy D. Perrier, Douglas B. Evans, Jeffrey E. Lee, William B. Inabnet, Steven K. Libutti, Herbert Chen, Quan Yang Duh, Scott Wilhelm

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1078-1086
Number of pages9
JournalSurgery
Volume138
Issue number6
DOIs
StatePublished - Dec 2005
Externally publishedYes

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Adrenocortical Carcinoma
Adrenalectomy
Glandular and Epithelial Neoplasms
Carcinoma
Recurrence
Standard of Care
Differential Diagnosis

ASJC Scopus subject areas

  • Surgery

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Gonzalez, R. J., Shapiro, S., Sarlis, N., Vassilopoulou-Sellin, R., Perrier, N. D., Evans, D. B., ... Wilhelm, S. (2005). Laparoscopic resection of adrenal cortical carcinoma: A cautionary note. Surgery, 138(6), 1078-1086. https://doi.org/10.1016/j.surg.2005.09.012

Laparoscopic resection of adrenal cortical carcinoma : A cautionary note. / Gonzalez, Ricardo J.; Shapiro, Suzanne; Sarlis, Nicholas; Vassilopoulou-Sellin, Rena; Perrier, Nancy D.; Evans, Douglas B.; Lee, Jeffrey E.; Inabnet, William B.; Libutti, Steven K.; Chen, Herbert; Duh, Quan Yang; Wilhelm, Scott.

In: Surgery, Vol. 138, No. 6, 12.2005, p. 1078-1086.

Research output: Contribution to journalArticle

Gonzalez, RJ, Shapiro, S, Sarlis, N, Vassilopoulou-Sellin, R, Perrier, ND, Evans, DB, Lee, JE, Inabnet, WB, Libutti, SK, Chen, H, Duh, QY & Wilhelm, S 2005, 'Laparoscopic resection of adrenal cortical carcinoma: A cautionary note', Surgery, vol. 138, no. 6, pp. 1078-1086. https://doi.org/10.1016/j.surg.2005.09.012
Gonzalez RJ, Shapiro S, Sarlis N, Vassilopoulou-Sellin R, Perrier ND, Evans DB et al. Laparoscopic resection of adrenal cortical carcinoma: A cautionary note. Surgery. 2005 Dec;138(6):1078-1086. https://doi.org/10.1016/j.surg.2005.09.012
Gonzalez, Ricardo J. ; Shapiro, Suzanne ; Sarlis, Nicholas ; Vassilopoulou-Sellin, Rena ; Perrier, Nancy D. ; Evans, Douglas B. ; Lee, Jeffrey E. ; Inabnet, William B. ; Libutti, Steven K. ; Chen, Herbert ; Duh, Quan Yang ; Wilhelm, Scott. / Laparoscopic resection of adrenal cortical carcinoma : A cautionary note. In: Surgery. 2005 ; Vol. 138, No. 6. pp. 1078-1086.
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abstract = "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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AU - Perrier, Nancy D.

AU - Evans, Douglas B.

AU - Lee, Jeffrey E.

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AU - Duh, Quan Yang

AU - Wilhelm, Scott

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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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