Department of Urology and Paediatric Urology, University Hospital, University of Würzburg, Würzburg, Germany.
Eur Urol. 2010 Oct;58(4):609-15. doi: 10.1016/j.eururo.2010.06.024. Epub 2010 Jun 22.
The role of laparoscopic adrenalectomy in the treatment of patients with adrenocortical carcinoma (ACC) is controversial.
Our aim was to compare oncologic outcome in patients with ACC who underwent either open adrenalectomy (OA) or laparoscopic adrenalectomy (LA) for localised disease.
DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective analysis of 152 patients with stage I-III ACC with a tumour < or =10 cm registered with the German ACC Registry.
Patients were stratified into two groups according to the surgical procedure (LA or OA). For comparison, we used both a matched pairs approach by selecting for each patient from the LA group (n=35) one corresponding patient from the OA group (n=117) and multivariate analysis in all 152 patients.
Disease-specific survival was chosen as the predefined primary end point. Secondary end points were recurrence-free survival, frequency of tumour capsule violation and postoperative peritoneal carcinomatosis, and incidence and reasons for conversion from LA to OA.
LA and OA did not differ with regard to the primary end point using either the matched pairs approach (hazard ratio [HR] for death: 0.79; 95% confidence interval [CI], 0.36-1.72; p=0.55) or multivariate analysis (HR for death: 0.98; 95% CI, 0.51-1.92; p=0.92). Similarly, adjusted recurrence-free survival was not different between LA and OA (HR: 0.91; 95% CI, 0.56-1.47; p=0.69). Frequency of tumour capsule violation and peritoneal carcinomatosis were comparable between groups. In 12 of 35 patients of the LA group, surgery was converted to open surgery with no impact on the clinical outcome.
For localised ACC with a diameter of < or =10 cm, LA by an experienced surgeon is not inferior to OA with regard to oncologic outcome.
腹腔镜肾上腺切除术在治疗肾上腺皮质癌（ACC）患者中的作用存在争议。
我们旨在比较局部 ACC 患者接受开放性肾上腺切除术（OA）或腹腔镜肾上腺切除术（LA）治疗的肿瘤学结果。
设计、设置和参与者：我们对德国 ACC 登记处登记的 152 例 I-III 期 ACC 患者进行了回顾性分析，这些患者的肿瘤直径<或=10cm。
根据手术方式（LA 或 OA）将患者分为两组。为了进行比较，我们使用了配对方法，即从 LA 组（n=35）中为每位患者选择一个来自 OA 组（n=117）的相应患者，以及对所有 152 例患者进行多变量分析。
疾病特异性生存率被选为预定的主要终点。次要终点包括无复发生存率、肿瘤包膜侵犯和术后腹膜癌病的频率，以及 LA 转为 OA 的发生率和原因。
使用配对方法（死亡的危险比[HR]：0.79；95%置信区间[CI]，0.36-1.72；p=0.55）或多变量分析（死亡的 HR：0.98；95%CI，0.51-1.92；p=0.92），LA 和 OA 在主要终点方面没有差异。同样，LA 和 OA 之间的调整后无复发生存率也没有差异（HR：0.91；95%CI，0.56-1.47；p=0.69）。两组之间肿瘤包膜侵犯和腹膜癌病的发生率相似。在 LA 组的 35 例患者中，有 12 例手术转为开放性手术，但对临床结果没有影响。
对于直径<或=10cm 的局限性 ACC，由经验丰富的外科医生进行 LA 并不劣于 OA 的肿瘤学结果。
