American Association of Endocrine Surgeons- Annual Meeting Abstract Papers

LAPAROSCOPIC RESECTION OF ADRENAL CORTICAL CARCINOMA: A CAUTIONARY NOTE
Ricardo Gonzalez, MD, Suzanne Shapiro, MS, BS, Nicholas Sarlis, MD, PhD, Rena Vassilopoulou-Sellin, MD, Nancy Perrier, MD, Douglas Evans, MD, and Jeffrey Lee, MD
The University of Texas M. D. Anderson Cancer Center, Houston, Texas

Background: Complete surgical resection remains the only potentially curative treatment for adrenal cortical carcinoma (ACC). While there is consensus in favor of the laparoscopic removal of relatively small benign functioning adrenal tumors, laparoscopic resection of incidentally discovered adrenal tumors that may be ACC remains controversial.
Methods: We reviewed the records of all patients with ACC evaluated at our institution from 1991-2004. Patients who underwent adrenalectomy prior to referral as well as patients who underwent surgery at our institution were included. Surgical treatments and outcomes were compared to identify the incidence and patterns of recurrence.
Results: Of 169 patients who presented with primary ACC, 163 underwent an open adrenalectomy and 6 underwent laparoscopic adrenalectomy (all laparoscopic resections were performed prior to referral). Median tumor size among patients who underwent laparoscopic adrenalectomy for ACC was 5 cm (range 3-8 cm). At a median follow-up of 11 months, 25 (15%) of 163 patients treated with an open operation were free of disease, 69 (42%) were alive with disease, and 69 (42%) had died. Among 138 patients who recurred following an open operation, local-regional recurrence (LR) was identified in 23 patients (14%; local 10, peritoneal carcinomatosis 7, both 6). In contrast, all 6 patients who underwent laparoscopic resection of ACC recurred, and 5 died of disease. LR was a component of initial recurrence in 5 of 6 patients resected via laparoscopy (local 2, carcinomatosis 1, both 2) (LR open vs. laparoscopy Fisher Exact Test P<0.001).
Conclusions: While recurrence is common following surgery for ACC, laparoscopic resection of ACC is associated with a very high risk of local-regional tumor recurrence and subsequent death from metastatic ACC. Open adrenalectomy remains the standard of care for patients presenting with an adrenal cortical tumor for which ACC remains in the differential diagnosis, including patients with an incidentaloma.