Impact of Laparoscopic Adrenalectomy on Overall Survival in Patients with Nonmetastatic Adrenocortical Carcinoma

Abstract

Appropriate use of laparoscopic adrenalectomy (LA) for adrenocortical carcinoma (ACC) remains controversial because complete resection with negative margins is the best chance for potential cure. This study compared the oncologic outcomes and overall survival (OS) of LA and open adrenalectomy (OA) for ACC. A retrospective analysis of the National Cancer Data Base (NCDB) between 2010 and 2014 identified 423 European Network for the Study of Adrenal Tumors (ENSAT) stage I to III ACC patients who had LA (n= 137) or OA (n= 286). Outcomes and OS were compared between the 2 groups. Patients who underwent OA had more advanced stage disease (p= 0.0001), larger (≥5 cm) tumors (p < 0.0001), and were younger (age less than 55 years, p= 0.05). Nodal assessment was rare in LA (n= 4) compared with OA (n= 88) (p < 0.0001). Margin positivity was affected only by surgical approach in patients with T3 tumors (LA 54.6% vs OA 21.7%; p= 0.0009). Neither surgical procedure nor any socio-demographic factor(s) affected OS for the entire cohort. Only positive margins (p= 0.007), positive nodes (p=0.02), tumor extension (p= 0.01), and more advanced ENSAT stage (p=0.004) increased mortality. When stratified by disease stage, LA decreased OS forpatients with stage II disease (p=0.04), and remained an independent risk factor for death on multivariate analysis (hazard ratio [HR] 1.86, 95% CI 1.02 to 3.38; p= 0.04). Only positive margins decreased OS in the entire cohort (HR 2.17, 95% CI 1.32 to 3.57; p= 0.002). Use of LA may decrease OS in select patients with ACC. Because margin status remains the strongest predictor of mortality, caution should be used in selecting LA for patients with ACC.