ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 63 P824 | DOI: 10.1530/endoabs.63.P824

Laparoscopic adrenalectomy for adrenocortical carcinoma is not inferior to open adrenalectomy

Ivana Kraljevic1, Nikola Knezevic2, Luka Kakarigi3, Marko Kastelan3, Tina Dusek1, Mirsala Solak1, Tanja Skoric Polovina1, Annemarie Balasko1, Ana-Marija Alduk4, Martina Zidanic4 & Darko Kastelan1

1Department of Endocrinology, University Hospital Center Zagreb, Zagreb, Croatia; 2Department of Urology University Hospital Centre Zagreb, Zagreb, Croatia; 3School of Medicine, University of Zagreb, Zagreb, Croatia; 4Department of Radiology, University Hospital Centre Zagreb, Zagreb, Croatia.

Background: Laparoscopic adrenalectomy (LA) is the standard treatment for benign adrenal tumours but its role in the surgical management of adrenocortical carcinoma (ACC) is controversial. Therefore, the aim of this study was to compare long-term outcome between open adrenalectomy (OA) and LA in the treatment of primary ACC.

Methods: This retrospective cohort study included patients with ACC ENSAT stage I-III referred to the Croatian referral centre for adrenal gland disorders from 2004 to 2018. Main outcomes analyzed in the study were: recurrence free survival (RFS) and disease-specific survival (DSS).

Results: Among 57 consecutive patients, 44 met the inclusion criteria for the study (ACC stage I-III). The patients who underwent LA (n=22) had significantly smaller tumours compared to those who underwent OA (70.5 (26–110) mm vs 120 (70–250) mm, P<0.001). There were no differences between the groups regarding gender, age, tumour functional status, Ki-67 labelling index and Weiss score. Median follow-up for patients who underwent LA and OA was 36.5 (3–133) and 64 (9–163) months respectively (P=0.12). Five patients in OA group (22.7%) and three patients in LA group (13.6%) had tumour recurrence (P=0.698). Three patients died during follow-up. One death in OA group was related to ACC, whereas two deaths in LA group were not related to ACC. The 5-year RFS and DSS calculated by Kaplan-Meier method was 86.4% and 90.9% for LA and 77.3% and 86.4% for OA with respective P values of 0.664 and 0.495.

Conclusions: There is no difference between LA and OA in the long-term outcome of patients with ACC treated in an expert centre. These results imply that LA could represent a suitable surgical approach in a number of patients with non-metastatic ACC.