title: Long-term survival after adrenalectomy for stage I/II adrenocortical carcinoma (ACC): a retrospective comparative cohort study of laparoscopic versus open approach.
abstract: BACKGROUND
  Laparoscopic adrenalectomy (LA) is the standard treatment for benign adrenal lesions. The laparoscopic approach has also been increasingly accepted for adrenal metastases but remains controversial for adrenocortical carcinoma (ACC). In a retrospective cohort study we compared the outcome of LA versus open adrenalectomy (OA) in the treatment of stage I and II ACC.
  
  
  METHODS
  This was a double cohort study comparing the outcome of patients with stage I/II ACC and a tumor size <10 cm submitted to LA or OA at Lille University Hospital referral center from 1985 to 2011. Main outcomes analyzed were: postoperative morbidity, overall survival, and disease-free survival.
  
  
  RESULTS
  Among 111 consecutive patients operated on for ACC, 34 met the inclusion criteria. LA and OA were performed in 13 and 21 patients, respectively. Baseline patient characteristics (gender, age, tumor size, hormonal secretion) were similar between groups. There was no difference in postoperative morbidity, but patients in LA group were discharged earlier (p < 0.02). After a similar follow-up (66 ± 52 for LA and 51 ± 43 months for OA), Kaplan-Meier estimates of disease-specific survival and disease-free survival were identical in both groups (p = 0.65, p = 0.96, respectively).
  
  
  CONCLUSIONS
  LA was associated with a shorter length of stay and did not compromise the long-term oncological outcome of patients operated on for stage I/II ACC ≤ 10 cm ACC. Our results suggest that LA can be safely proposed to patients with potentially malignant adrenal lesions smaller than 10 cm and without evidence of extra-adrenal extension.
authors.affiliation: Department of General and Endocrine Surgery, Lille Regional University Hospital, Lille, France.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Donatini
authors.forename: Robert
authors.initials: R
authors.lastname: Caiazzo
authors.forename: Christine
authors.initials: C
authors.lastname: Do Cao
authors.forename: Sebastien
authors.initials: S
authors.lastname: Aubert
authors.forename: Carlos
authors.initials: C
authors.lastname: Zerrweck
authors.forename: Ziad
authors.initials: Z
authors.lastname: El-Kathib
authors.forename: Thomas
authors.initials: T
authors.lastname: Gauthier
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Leteurtre
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Wemeau
authors.forename: Marie Christine
authors.initials: MC
authors.lastname: Vantyghem
authors.forename: Bruno
authors.initials: B
authors.lastname: Carnaille
authors.forename: Francois
authors.initials: F
authors.lastname: Pattou
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000315:Adrenalectomy / Q000401:mortality*; D018268:Adrenocortical Carcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors