title: Comparative outcomes of laparoscopic and open adrenalectomy for adrenocortical carcinoma: single, high-volume center experience.
abstract: OBJECTIVE
  Adrenocortical carcinoma (ACC) is a rare and clinically aggressive cancer. Previous studies reported increased recurrence rates associated with laparoscopic adrenalectomy (LA). We evaluated a single-center experience of LA versus open adrenalectomy (OA) for the management of ACC.
  
  
  METHODS
  Between 1993 and 2011, 44 consecutive patients with primary ACC were treated at our institution. Baseline patient characteristics and surgical and pathological outcomes were compared between OA and LA groups. Multivariable Cox proportional hazards analysis was used to estimate the association between OA versus LA with recurrence-free and overall survival.
  
  
  RESULTS
  Eighteen and 26 patients underwent LA and OA, respectively. Patients who underwent OA had larger tumors and more advanced clinical stage compared with LA group. During a median follow-up of 22 months, 22 recurrences and 26 deaths were observed. The 2-year, recurrence-free and overall survivals for OA and LA were 60 vs. 39 % (P = 0.7) and 54 vs. 58 % (P = 0.6), respectively. After adjusting for clinical stage, OA was associated with lower risk of recurrence (hazard ratio (HR) 0.4; 95 % confidence interval (CI) 0.2-1.2; P = 0.099) and improved overall survival (HR 0.5; 95 % CI 0.2-1.2; P = 0.122) compared with LA, although differences were not statistically significant.
  
  
  CONCLUSIONS
  A nonstatistically significant increase in recurrence and death was observed among patients undergoing LA versus OA after adjusting for clinical stage. The rarity of this disease limits the ability to assess for significant differences in a single-institution series. Patients with suspected ACC should be considered for OA.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Mir
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Klink
authors.forename: Julien
authors.initials: J
authors.lastname: Guillotreau
authors.forename: Jean-Alexandre
authors.initials: JA
authors.lastname: Long
authors.forename: Ranko
authors.initials: R
authors.lastname: Miocinovic
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.forename: Matthew N
authors.initials: MN
authors.lastname: Simmons
authors.forename: Eric
authors.initials: E
authors.lastname: Klein
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Krishnamurthi
authors.forename: Steven C
authors.initials: SC
authors.lastname: Campbell
authors.forename: Amr F
authors.initials: AF
authors.lastname: Fergany
authors.forename: Jordan
authors.initials: J
authors.lastname: Reynolds
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Stephenson
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000556:secondary / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D016016:Proportional Hazards Models; D016896:Treatment Outcome