Key result
Minimally invasive adrenalectomy and tumor size did not affect survival, but conversion to open surgery (HR 1.83, p=0.02) and positive margins (HR 1.54, p=0.01) were associated with poor survival.
Why the study?
Adrenocortical carcinoma is often considered a contraindication to minimally invasive adrenalectomy, and the study aimed to evaluate whether small tumors yield better postoperative outcomes regardless of operative approach.
Does minimally invasive adrenalectomy compared to open adrenalectomy affect margin positivity and survival in patients with adrenocortical carcinoma of varying tumor sizes?
Cohort (n=999)
Yes
Does minimally invasive adrenalectomy compared to open adrenalectomy affect margin positivity and survival in patients with adrenocortical carcinoma of varying tumor sizes?
In adrenocortical carcinoma, positive margins and conversion to open surgery are associated with poor survival, suggesting minimally invasive approaches should be reserved for select small tumors where adequate oncologic resection is achievable.
Conversion to open surgery and positive margins were associated with poorer survival; leaves open whether minimally invasive adrenalectomy is oncologically safe in adrenocortical carcinoma.
BACKGROUND: Adrenocortical carcinoma (ACC) is often a contraindication to minimally invasive adrenalectomy (MIA). We used an administrative data set to analyze postoperative outcomes. We hypothesized that small tumors would have better short- and long-term outcomes, independent of the operative approach. METHODS: The National Cancer Database (2010-2016) identified patients with ACC who underwent adrenalectomy. Tumors were grouped: <5 cm (n = 125), 5-10 cm (n = 431), and >10 cm (n = 443). The primary and secondary outcomes were margin positivity and overall survival, respectively. RESULTS: Nine hundred and ninety-nine patients were analyzed: 37% MIA and 63% open adrenalectomy (OA). As the size increased, the rate of attempted MIA decreased. Larger tumors were associated with conversion to open. Although tumors with local invasion and those which required conversion to open were associated with an increased likelihood of a positive margin, tumor size was not. Although "complete" MIA (vs. OA) and tumor size were not associated with differences in survival, conversion (HR = 1.83, p = .02), positive margins (HR = 1.54, p = .01), and local invasion (HR = 1.84, p < .001) were associated with poor survival. CONCLUSION: Positive margins are associated with poor survival in ACC. Tumors ≥ 5 cm were associated with an increased conversion rate and subsequent increase in margin positivity. MIA may be considered for select patients with small tumors but adequate oncologic resection is critical.
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Hue et al. (2021) conducted a cohort in Adrenocortical carcinoma (n=999). Minimally invasive adrenalectomy vs. Open adrenalectomy was evaluated on Margin positivity. Minimally invasive adrenalectomy and tumor size did not affect survival, but conversion to open surgery (HR 1.83, p=0.02) and positive margins (HR 1.54, p=0.01) were associated with poor survival.
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