Open versus laparoscopic adrenalectomy for localised adrenocortical carcinoma.

OBJECTIVE: The purpose of the study was to compare the long-term outcomes of patients with localized adrenocortical carcinoma (ACC) subjected to open versus laparoscopic surgery. DESIGN: Retrospective study. PATIENTS: This retrospective study included 46 patients with the ACC ENSAT stage I-III of whom 23 underwent open surgery (OA group) whereas 23 were subjected to laparoscopic adrenalectomy (LA group). The main outcomes analysed in the study were differences between the OA and LA groups in recurrence free survival (RFS) and overall survival (OS). RESULTS: Patients in OA group had larger tumours (120 (70-250) mm vs. 75 (26-110) mm; p<0.001), higher Ki-67 index (16 (1-65) % vs. 10 (1-25) %; p=0.04) and higher disease stage (p=0.01) compared to the patients in the LA group. The median duration of follow-up for patients underwent OA and LA was 51 (12-174) and 53 (5-127) months, respectively. Eight patients (5 OA, 3 LA) experienced recurrent disease whereas six patients (3 OA, 3 LA) died during follow-up. No differences in RFS and OS were found between patients who underwent open or laparoscopic surgery. CONCLUSION: The study demonstrated that in patients with localised ACC and without invasion of extra-adrenal tissues LA is a plausible treatment option in terms of RFS and OS. However, our results are limited to referral centres with large experience in the management of patients with ACC and may not necessarily apply to nonspecialised centres.