Surgical quality of minimally invasive adrenalectomy for adrenocortical carcinoma: a contemporary analysis using the National Cancer Database

Abstract

For organ-confined disease, MIA offers comparable surgical quality to OA, while expediting inpatient recovery. OA is associated with superior outcomes for locally advanced disease.

Reassessing the impact of tumor size on operative approach in adrenocortical carcinoma

“…Previous reports using administrative data and institutional data similarly demonstrated that tumor size was not a predictor of survival, whereas advanced T‐stage (i.e., local invasion 21 ) was associated with poor survival 23,24 . Past studies have reported a trend toward a higher likelihood of margin positivity among tumors ≥ 10 cm when resected via a minimally invasive approach as compared to OA, 25 but this was not demonstrated in our study. Similar to our report, greater tumor size has been associated with an increased likelihood of conversion from MIA to OA 6,7,19 .…”

Contemporary minimally invasive surgery for adrenal masses: it's not all about (pure) laparoscopy

“…The authors concluded that open adrenalectomy should still be considered the standard surgical management in this setting, but laparoscopy man play a role in carefully selected cases without jeopardising oncological outcomes . Similar conclusions were drawn by Maurice et al in a recent analysis of 481 patients form the National Cancer Database. They concluded that MIS adrenalectomy can offer comparable surgical quality to open, while expediting inpatient recovery, but open adrenalectomy holds superior outcomes for locally advanced disease.…”

“…The authors concluded that open adrenalectomy should still be considered the standard surgical management in this setting, but laparoscopy man play a role in carefully selected cases without jeopardising oncological outcomes [7]. Similar conclusions were drawn by Maurice et al [8] In conclusion, the surgical management of adrenal masses remains an interesting area for discussion. Maturing evidence, from both the urological and general surgical literature alike, shows that MIS plays a major role for the vast majority of adrenal pathologies, with a caveat for adrenal cancer (Fig.…”

Risk factors for 30-day readmission after adrenalectomy

“…Although open adrenalectomy has been associated with a grater duration of stay, most studies have failed to identify a significant difference in readmission rates for open compared to minimally invasive adrenalectomy. 7, 815 In the current study, we identified an increase in readmission rate for open adrenalectomy, which remained statistically significant and clinically important on multivariate analysis. A previous study reported a trend for increased readmission for open adrenalectomy compared to a minimally invasive approach, and the failure to identify a difference may have been due to the lower number of patients in the previous report.…”

“…A previous study reported a trend for increased readmission for open adrenalectomy compared to a minimally invasive approach, and the failure to identify a difference may have been due to the lower number of patients in the previous report. 15 Intraoperative adverse events have been shown to increase the risk of readmission in patients undergoing abdominal operations. 16 Avoidance of intraoperative complications may account for the reported association between decreased complications and lesser rates of readmission after adrenalectomy for high-volume surgeons.…”