title: Resection of adrenocortical carcinoma is less complete and local recurrence occurs sooner and more often after laparoscopic adrenalectomy than after open adrenalectomy.
abstract: BACKGROUND
  Controversy surrounds the use of laparoscopy for resection of adrenocortical carcinoma. We evaluated the hypothesis that outcome is equivalent in patients undergoing laparoscopic adrenalectomy versus open adrenalectomy.
  
  
  METHODS
  This is a retrospective review of 217 patients (156 patients with stage I-III cancer) with adrenocortical carcinoma referred to a single institution between 2005 and 2011. Outcome and operative data were assessed for the subset undergoing resection with curative intent. Student t and Fisher exact tests and the Kaplan-Meier method were used to compare data (P ≤ .05 was considered statistically significant).
  
  
  RESULTS
  One hundred fifty-six patients (64% female; median age, 47 years [range, 18-80]; median follow-up, 26.5 months [range, 1-188]) were identified. Forty-six patients underwent laparoscopic adrenalectomy, and 110 underwent open adrenalectomy. Twenty-seven percent of laparoscopic adrenalectomy patients had stage III cancer. After laparoscopic adrenalectomy, 30% had positive margins or intraoperative tumor spill compared to 16% of the open adrenalectomy patients (P = .04). Overall survival for patients with stage II cancer was longer in those undergoing open adrenalectomy (P = .002). Time to visible tumor bed recurrence or peritoneal recurrence in stage II patients was shorter in laparoscopic adrenalectomy patients (P = .002).
  
  
  CONCLUSIONS
  Open adrenalectomy is superior to laparoscopic adrenalectomy for adrenocortical carcinoma based on completeness of resection, site and timing of initial tumor recurrence, and survival in stage II patients. Intraoperative evaluation is insensitive for the detection of stage III tumors.
authors.affiliation: Division of Endocrine Surgery, Section of General Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA. barbram@umich.edu
authors.forename: Barbra S
authors.initials: BS
authors.lastname: Miller
authors.forename: Paul G
authors.initials: PG
authors.lastname: Gauger
authors.forename: Gary D
authors.initials: GD
authors.lastname: Hammer
authors.forename: Gerard M
authors.initials: GM
authors.lastname: Doherty
mesh_terms: D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy; D018268:Adrenocortical Carcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D015996:Survival Rate; D055815:Young Adult