Source: DGNews  |  Posted 2 years ago

By Chris Berrie

ISTANBUL, Turkey -- April 27, 2009 -- When comparing minimally invasive adrenalectomy and open adrenalectomy, the prognosis for patients with adrenocortical carcinoma (ACC) of 10 cm or less does not differ, researchers stated here at the 11th European Congress of Endocrinology (ECE).

Similarly, although intraoperative conversion from minimally invasive to open surgery is frequently necessary, it has no negative impact on patient prognosis.

Presenting a combined matched-control and multivariate retrospective analysis on April 26 on behalf of the German ACC Registry Group, principal investigator Martin Fassnacht, MD, Department of Medicine I, University Hospital, Würzburg, Germany, said that initially the treatment of choice for patients with ACC was complete tumour removal as R0 resection by an expert surgeon using open surgery.

However, "since 1992, minimally invasive adrenalectomy has become the treatment of choice for benign adrenal lesions with a diameter less than 6 cm, because this has less pain, a shorter hospital stay, and better cosmetic results."

With a great lack of published studies here, Dr. Fassnacht said that their primary question was, "Is minimally invasive adrenalectomy for small ACCs [<=10 cm] inferior to open adrenalectomy?"

The inclusion criteria for this analysis of patients in the German ACC Registry (n = 521) defined the period of surgery from 1996 to 2007, and as tumours 10 cm or less with no evidence of distant metastases at surgery, and with follow-up more than 6 months or until patient death. This provided 135 patients, with 27 with minimally invasive adrenalectomy.

The primary endpoint was overall survival (OS). Secondary endpoints were recurrence-free survival (RFS), frequency of local/abdominal recurrence, conversion rate (from minimally invasive to open surgery), and complications.

In their first matched-control analysis, the 27 patients with minimally invasive adrenalectomy were matched with 27 with open surgery for (respectively): age (50.8 vs 52.3 years); sex (male, 26% vs 26%); tumour size (7.0 vs 6.5 cm) and stage (European Network for the Study of Adrenal Tumours [ENSAT] I/II/III, 10/14/3 vs 6/16/5); and adjuvant therapy (26% vs 15%). These groups were also well matched for hormone excess (80% vs 74%) and median follow-up (33 vs 21 months).

For the endpoints of OS, RFS, and local recurrence, there were no significant differences between the 2 surgery groups. Furthermore, despite relatively high conversion from minimally invasive adrenalectomy to open surgery (41%) due to complications, there was no significant negative impact of this conversion on OS.

The second analysis was a multivariate Cox regression analysis model with all 135 patients included. Following adjustments for age, tumour size and stage, and adjuvant therapy, there were again no significant differences in the hazard ratios for death, recurrence, and local recurrence between the 2 surgery groups.

Although Dr. Fassnacht indicated the need for caution in the interpretation of these data due to their retrospective nature, he concluded that "it seems to be justified to perform minimally invasive surgery on patients with small adrenal tumours."

[Presentation title: Long-Term Outcome of Laparoscopic Versus Open Adrenalectomy for Adrenocortical Carcinoma. Abstract OC1.2]