Laparoscopic versus open adrenalectomy for adrenocortical carcinoma: surgical and oncologic outcome in 152 patients
| Autor: | Stefanie Hahner, Peter Langer, Wiebke Fenske, David Brix, Bruno Allolio, Martin Spahn, Martin Fassnacht, Christoph Nies, Ayman Agha, Dirk Weismann, Henning Dralle, Christian Jurowich, Thomas Mussack, Hubertus Riedmiller |
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| Rok vydání: | 2010 |
| Předmět: |
Nephrology
Adult Male medicine.medical_specialty Urology medicine.medical_treatment Young Adult Internal medicine medicine Clinical endpoint Adrenocortical Carcinoma Adrenocortical carcinoma Humans Stage (cooking) Laparoscopy Aged Retrospective Studies Aged 80 and over medicine.diagnostic_test business.industry Adrenalectomy Hazard ratio Retrospective cohort study Middle Aged medicine.disease Adrenal Cortex Neoplasms Surgery Treatment Outcome Female business |
| Zdroj: | European urology. 58(4) |
| ISSN: | 1873-7560 |
| Popis: | Background The role of laparoscopic adrenalectomy in the treatment of patients with adrenocortical carcinoma (ACC) is controversial. Objective Our aim was to compare oncologic outcome in patients with ACC who underwent either open adrenalectomy (OA) or laparoscopic adrenalectomy (LA) for localised disease. Design, setting, and participants We conducted a retrospective analysis of 152 patients with stage I–III ACC with a tumour ≤10cm registered with the German ACC Registry. Intervention Patients were stratified into two groups according to the surgical procedure (LA or OA). For comparison, we used both a matched pairs approach by selecting for each patient from the LA group ( n =35) one corresponding patient from the OA group ( n =117) and multivariate analysis in all 152 patients. Measurements Disease-specific survival was chosen as the predefined primary end point. Secondary end points were recurrence-free survival, frequency of tumour capsule violation and postoperative peritoneal carcinomatosis, and incidence and reasons for conversion from LA to OA. Results and limitations LA and OA did not differ with regard to the primary end point using either the matched pairs approach (hazard ratio [HR] for death: 0.79; 95% confidence interval [CI], 0.36–1.72; p =0.55) or multivariate analysis (HR for death: 0.98; 95% CI, 0.51–1.92; p =0.92). Similarly, adjusted recurrence-free survival was not different between LA and OA (HR: 0.91; 95% CI, 0.56–1.47; p =0.69). Frequency of tumour capsule violation and peritoneal carcinomatosis were comparable between groups. In 12 of 35 patients of the LA group, surgery was converted to open surgery with no impact on the clinical outcome. Conclusions For localised ACC with a diameter of ≤10cm, LA by an experienced surgeon is not inferior to OA with regard to oncologic outcome. |
| Databáze: | OpenAIRE |
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