Lee Christina W, Salem Ahmed I, Schneider David F, Leverson Glen E, Tran Thuy B, Poultsides George A, Postlewait Lauren M, Maithel Shishir K, Wang Tracy S, Hatzaras Ioannis, Shenoy Rivfka, Phay John E, Shirley Lawrence, Fields Ryan C, Jin Linda X, Pawlik Timothy M, Prescott Jason D, Sicklick Jason K, Gad Shady, Yopp Adam C, Mansour John C, Duh Quan-Yang, Seiser Natalie, Solorzano Carmen C, Kiernan Colleen M, Votanopoulos Konstantinos I, Levine Edward A, Weber Sharon M
Department of Surgery, University of Wisconsin School of Medicine and Public Health, H4/730 Clinical Science Center, Madison, WI, 53792, USA.
Department of Surgery, Stanford University, Palo Alto, CA, USA.
J Gastrointest Surg. 2017 Feb;21(2):352-362. doi: 10.1007/s11605-016-3262-4. Epub 2016 Oct 21.
Minimally invasive surgery for adrenocortical carcinoma (ACC) is controversial. We sought to evaluate the perioperative and long-term outcomes following minimally invasive (MIS) and open resection (OA) of ACC in patients treated with curative intent surgery.
Retrospective data from patients who underwent adrenalectomy for primary ACC at 13 tertiary care cancer centers were analyzed, including demographics, clinicopathological, and operative outcomes. Outcomes following MIS were compared to OA.
A total of 201 patients were evaluated including 47 MIS and 154 OA. There was no difference in utilization of MIS approach among institutions (p = 0.24) or 30-day morbidity (29.3 %, MIS, vs. 30.9 %, OA; p = 0.839). The only preoperatively determined predictor for MIS was smaller tumor size (p < 0.001). There was no difference in rates of intraoperative tumor rupture (p = 0.612) or R0 resection (p = 0.953). Only EBL (p = 0.038) and T stage (p = 0.045) were independent prognostic indicators of overall survival after adjusting for significant factors. The surgical approach was not associated with overall or disease-free survival.
MIS adrenalectomy may be utilized for preoperatively determined ACC ≤ 10.0 cm; however, OA should be utilized for adrenal masses with either preoperative or intraoperative evidence of local invasion or enlarged lymph nodes, regardless of size.
肾上腺皮质癌（ACC）的微创手术存在争议。我们旨在评估接受根治性手术治疗的ACC患者行微创（MIS）和开放切除（OA）术后的围手术期及长期结局。
分析了13家三级癌症中心接受原发性ACC肾上腺切除术患者的回顾性数据，包括人口统计学、临床病理及手术结局。将MIS术后结局与OA术后结局进行比较。
共评估了201例患者，其中47例行MIS，154例行OA。各机构间MIS方法的使用率无差异（p = 0.24），30天发病率也无差异（MIS为29.3%，OA为30.9%；p = 0.839）。术前确定的唯一MIS预测因素是肿瘤体积较小（p < 0.001）。术中肿瘤破裂率（p = 0.612）或R0切除率（p = 0.953）无差异。调整显著因素后，仅估计失血量（p = 0.038）和T分期（p = 0.045）是总生存的独立预后指标。手术方式与总生存或无病生存无关。
MIS肾上腺切除术可用于术前确定的ACC≤10.0 cm；然而，对于术前或术中存在局部侵犯或淋巴结肿大证据的肾上腺肿块，无论大小，均应采用OA。
