title: Minimally Invasive Resection of Adrenocortical Carcinoma: a Multi-Institutional Study of 201 Patients.
abstract: Minimally invasive surgery for adrenocortical carcinoma (ACC) is controversial. We sought to evaluate the perioperative and long-term outcomes following minimally invasive (MIS) and open resection (OA) of ACC in patients treated with curative intent surgery.
  
  
  
  Retrospective data from patients who underwent adrenalectomy for primary ACC at 13 tertiary care cancer centers were analyzed, including demographics, clinicopathological, and operative outcomes. Outcomes following MIS were compared to OA.
  
  
  
  A total of 201 patients were evaluated including 47 MIS and 154 OA. There was no difference in utilization of MIS approach among institutions (p = 0.24) or 30-day morbidity (29.3 %, MIS, vs. 30.9 %, OA; p = 0.839). The only preoperatively determined predictor for MIS was smaller tumor size (p < 0.001). There was no difference in rates of intraoperative tumor rupture (p = 0.612) or R0 resection (p = 0.953). Only EBL (p = 0.038) and T stage (p = 0.045) were independent prognostic indicators of overall survival after adjusting for significant factors. The surgical approach was not associated with overall or disease-free survival.
  
  
  
  MIS adrenalectomy may be utilized for preoperatively determined ACC ≤ 10.0 cm; however, OA should be utilized for adrenal masses with either preoperative or intraoperative evidence of local invasion or enlarged lymph nodes, regardless of size.
authors: Department of Surgery, University of Wisconsin School of Medicine and Public Health, H4/730 Clinical Science Center, Madison, WI, 53792, USA.
authors: Christina W
authors: CW
authors: Lee
authors: Department of Surgery, University of Wisconsin School of Medicine and Public Health, H4/730 Clinical Science Center, Madison, WI, 53792, USA.
authors: Ahmed I
authors: AI
authors: Salem
authors: Department of Surgery, University of Wisconsin School of Medicine and Public Health, H4/730 Clinical Science Center, Madison, WI, 53792, USA.
authors: David F
authors: DF
authors: Schneider
authors: Department of Surgery, University of Wisconsin School of Medicine and Public Health, H4/730 Clinical Science Center, Madison, WI, 53792, USA.
authors: Glen E
authors: GE
authors: Leverson
authors: Department of Surgery, Stanford University, Palo Alto, CA, USA.
authors: Thuy B
authors: TB
authors: Tran
authors: Department of Surgery, Stanford University, Palo Alto, CA, USA.
authors: George A
authors: GA
authors: Poultsides
authors: Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
authors: Lauren M
authors: LM
authors: Postlewait
authors: Department of Surgery, Stanford University, Palo Alto, CA, USA.
authors: Shishir K
authors: SK
authors: Maithel
authors: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors: Tracy S
authors: TS
authors: Wang
authors: Department of Surgery, New York University School of Medicine, New York, NY, USA.
authors: Ioannis
authors: I
authors: Hatzaras
authors: Department of Surgery, New York University School of Medicine, New York, NY, USA.
authors: Rivfka
authors: R
authors: Shenoy
authors: Department of Surgery, Ohio State University, Columbus, OH, USA.
authors: John E
authors: JE
authors: Phay
authors: Department of Surgery, Ohio State University, Columbus, OH, USA.
authors: Lawrence
authors: L
authors: Shirley
authors: Department of Surgery, Washington University, St. Louis, MO, USA.
authors: Ryan C
authors: RC
authors: Fields
authors: Department of Surgery, Washington University, St. Louis, MO, USA.
authors: Linda X
authors: LX
authors: Jin
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Timothy M
authors: TM
authors: Pawlik
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Jason D
authors: JD
authors: Prescott
authors: Department of Surgery, University of California, San Diego, CA, USA.
authors: Jason K
authors: JK
authors: Sicklick
authors: Department of Surgery, University of California, San Diego, CA, USA.
authors: Shady
authors: S
authors: Gad
authors: Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors: Adam C
authors: AC
authors: Yopp
authors: Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors: John C
authors: JC
authors: Mansour
authors: Department of Surgery, University of California, San Francisco, CA, USA.
authors: Quan-Yang
authors: QY
authors: Duh
authors: Department of Surgery, University of California, San Francisco, CA, USA.
authors: Natalie
authors: N
authors: Seiser
authors: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors: Carmen C
authors: CC
authors: Solorzano
authors: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors: Colleen M
authors: CM
authors: Kiernan
authors: Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
authors: Konstantinos I
authors: KI
authors: Votanopoulos
authors: Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
authors: Edward A
authors: EA
authors: Levine
authors: Department of Surgery, University of Wisconsin School of Medicine and Public Health, H4/730 Clinical Science Center, Madison, WI, 53792, USA. webers@surgery.wisc.edu.
authors: Sharon M
authors: SM
authors: Weber
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy; D018268:Adrenocortical Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
keywords: Adrenocortical carcinoma; Disease-free survival; Minimally invasive surgery; Surgical approach; Survival