Open versus laparoscopic adrenalectomy and comparison of laparoscopic approaches for adrenocortical carcinoma

Comparative studies on different surgery approaches for adrenocortical carcinoma (ACC) remains controversial. This retrospective study aimed to compare the overall survival (OS), disease-free survival (DFS) of open versus laparoscopic adrenalectomy and different laparoscopic approaches in ACC. From 2000 to 2024, we retrospectively analyzed a total of 154 ACC patients with stage I–III who underwent either OA or LA. Propensity score matching (PSM) was performed to balance baseline characteristics between the OA and LA groups, as well as among subgroups within the LA group. The primary outcomes of the study were OS and DFS. Survival analyses were conducted using the Kaplan–Meier method, and the log-rank test was employed to compare survival curves. Univariate and multivariate Cox proportional hazards models were utilized to identify variables affecting OS and DFS. Regarding perioperative and survival outcomes, the LA group demonstrated significantly shorter operative times (unmatched cohort: p < 0.001; matched cohort: p = 0.001) and reduced lengths of hospital stay (unmatched cohort: p = 0.001; matched cohort: p = 0.017) compared to the OA group. There were no significant differences in the incidence of tumor rupture, mortality rate, OS, recurrence, or DFS. And in the comparison of retroperitoneal (RLA) and transabdominal laparoscopic adrenalectomy (TLA), RLA was superior to TLA in operative time, with no significant advantages observed in other outcomes. Long-term survival analyses revealed no significant differences in OS or DFS between the matched and unmatched OA and LA groups. Furthermore, the type of laparoscopic approach did not influence OS or DFS. Notably, T stage and tumor size emerged as significant predictors of poorer survival outcomes in both surgical cohorts. For localized ACC (stage I–III), LA and OA demonstrate comparable long-term oncological outcomes in terms of OS and DFS. Both TLA and RLA appear to be safe and effective surgical interventions for the management of localized ACC.