Minimally invasive adrenalectomy (MIA) and open adrenalectomy (OA) for adrenocortical carcinoma offer similar overall survival and positive surgical margin (PSM) rates regardless of mass size, according to a recent report.
Current guidelines recommend OA for masses larger than 6 cm, and this should remain the preferred approach, “but for appropriately selected patients in which the oncological principles of surgery can be respected and negative surgical margins can be achieved, MIA may result in similar oncological outcomes,” Kevin B. Ginsburg, MD, MS, of Fox Chase Cancer Center in Philadelphia, Pennsylvania, and colleagues concluded in a paper published in Urologic Oncology.
Dr Ginsburg’s team analyzed data from the National Cancer Database on 364 patients who had surgery for adrenocortical carcinoma from 2010 to 2017: 182 who underwent MIA and 182 who had an OA. The investigators classified patients according to tumor size: 6 cm or less, 6.1-10 cm, and 10.1-20 cm and matched patients within each size stratum by propensity score.
The MIA and OA groups had PSM rates of 21% and 18%, respectively. The investigators found no significant association between surgical approach and PSM rates or overall survival in the cohort as a whole or within each size strata.
The investigators explained that due to the poor prognosis of patients with recurrent or metastatic adrenocortical carcinoma, “complete surgical resection is of paramount importance.” They noted that initial experiences of MIA for localized tumors raised concerns about oncologic efficacy of laparoscopic surgery for this cancer. “These studies suggested patients treated with MIA had an increased risk of tumor spillage, local recurrence, and worse survival.”
The authors acknowledged study limitations that they noted are inherent in retrospective analyses and use of registry data. “Despite covariate balance after propensity score matching, there remains the concern about residual and unmeasured confounding.” In addition, based on the data source they used, they could not ascertain the surgical expertise and how it was decided that patients were treated with MIA vs OA.
Ginsburg KB, Castro Bigalli AA, Schober JP, et al. Association of tumor size and surgical approach with oncological outcomes and overall survival in patients with adrenocortical carcinoma. Urol Oncol. Published online June 17, 2022. doi:10.1016/j.urolonc.2022.05.021