Adrenocortical carcinoma: is the surgical approach a risk factor of peritoneal carcinomatosis?
Sophie Leboulleux1, Désirée Deandreis1, Abir Al Ghuzlan1, Anne Aupérin1, Clarisse Dromain1, Jacques Young2, Martin Schlumberger1 & Eric Baudin1
Context: Peritoneal carcinomatosis (PC) is a rare site of distant metastasis in patients with adrenocortical cancer (ACC). One preliminary study suggests an increase risk of PC after adrenalectomy through laparoscopic approach of ACC.
Objective: The objective of the study was to search for risk factors of PC including surgical approach. This was a retrospective cohort study conducted in an institutional practice.
Patients: Sixty-four consecutive patients with ACC seen at our institution between 2003 and 2009 were included. Mean tumor size was 132 mm. Patients had stage I disease in 2 cases, stage II in 32 cases, stage III in 7 cases, stage IV in 21 cases and unknown stage in 2 cases. Surgery was open in 58 cases and laparoscopic in 6 cases.
Results: PC occurred in 18 (28%) patients. It was present at initial diagnosis in 3 cases and occurred during follow-up in 15 cases. The only risk factor of PC occurring during follow-up was the surgical approach with a 4-year rate of PC of 67% (95CI, 3090%) for laparoscopic adrenalectomy and 27% (95CI, 1544%) for open adrenalectomy (P=0.016). Neither tumor size, stage, functional status, completeness of surgery or plasmatic level of opDDD were associated with the occurrence of PC.
Conclusion: We found an increase risk of PC after laparoscopic adrenalectomy of ACC. Adrenal tumors bearing malignant characteristics preoperatively should be referred for open adrenalectomy.