Endocrine Abstracts (2009) 20 OC1.2

Long-term outcome of laparoscopic versus open adrenalectomy for adrenocortical carcinoma

Martin Fassnacht1, David Brix2, Wiebke Fenske1, Peter Langer3, Christoph Nies3, Ayman Agha4, Felix Beuschlein5, Sarah Johanssen1, Hubertus Riedmiller2 & Bruno Allolio1

1Department of Medicine I, University Hospital, Würzburg, Germany; 2Department of Urology, University Hospital, Würzburg, Germany; 3Department of Surgery, University Hospital, Marburg, Germany; 4Department of Surgery, University Hospital, Regensburg, Germany; 5Department of Medicine I, University Hospital, München, Germany.

Introduction: Surgery is the established first line treatment in adrenocortical carcinoma (ACC). For benign adrenal tumours, laparoscopic adrenalectomy (LA) has become the treatment of choice. However, the role of LA in ACC remains highly controversial. Data from the German ACC Registry were used to evaluate the technical feasibility of LA in ACC and to compare the long-term outcome after LA with the results of open adrenalectomy (OA).

Methods: Out of 521 patients in the German ACC Registry, we identified 135 patients with ACC stage I–III, a tumour size ≤10 cm, and a follow up time of at least 6 months. In this group 27 patients underwent LA. These patients were matched with regard to tumour size (mean diameter 7.0 vs 6.5 cm), tumour stage, adjuvant therapy, age, sex, and endocrine activity with 27 patients who underwent OA. Median follow-up was 35 months (6–138 months).

Results: The 5-year overall survival (OS) of the entire cohort of 54 patients was 62%. Time to recurrence (TTR) and OS did not differ significantly between LA and OA (TTR median 22 vs 15 months; HR 1.2; P=0.5; OS 40 vs 34 months; HR 1.7; P=0.2). In 11/27 patients, laparoscopic surgery had to be converted to an open procedure. Conversion had no negative impact on OS (P=0.4).

Conclusions: This is by far the largest series on LA in ACC and the first including matched controls. In contrast to previous concerns, our study indicates that LA in ACC patients with a tumour size ≤10 cm does not lead to earlier recurrence or inferior survival when compared to OA. Our data justify a randomized trial in selected patients with ACC comparing the two surgical approaches. However, due to the rarity of ACC such a trial is challenging and unlikely to be performed in the foreseeable future.

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