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Association of Surgical Approach With Treatment Burden, Oncological Effectiveness, and Perioperative Morbidity in Adrenocortical Carcinoma

Published:April 28, 2022DOI:https://doi.org/10.1016/j.clgc.2022.04.011

      Highlights

      • We tested if minimally invasive adrenalectomy (MIA) was associated with worse outcomes compared with open adrenalectomy (OA).
      • In the National Cancer Database, we noted patients treated with MIA had a similar cumulative treatment burden (use of any adjuvant treatment) and similar oncological effectiveness (positive surgical margins, lymph node yield, and overall survival) compared with open adrenalectomy.
      • Although the standard of care remains open surgery, in appropriately selected patients, MIA may offer equivalent oncological efficacy with less morbidity than OA.

      Abstract

      Microabstract

      In the National Cancer Database (NCDB), patients treated with minimally invasive adrenalectomy (MIA) for adrenocortical carcinoma (ACC) had similar oncological outcomes and cumulative treatment burden with less morbidity compared with open adrenalectomy (OA). Although OA remains the standard of care for adrenal lesions concerninge for malignancy, MIA in appropriately selected patients may offer equivalent oncological outcomes.

      Introduction/Background

      We investigated the cumulative treatment burden, oncological effectiveness, and perioperative morbidity in patients undergoing MIA compared with (OA) for patients with ACC.

      Patients and Methods

      We reviewed the NCDB for patients undergoing surgical resection (MIA vs. OA) for ACC from 2010 to 2017. Inverse probability of treatment weighted logistic regression, negative binomial, and Cox proportional hazards models were fit to assess for an association of surgical approach with cumulative treatment burden (any adjuvant therapy, radiation therapy [RT], and systemic therapy), oncological effectiveness (positive surgical margins [PSM], lymph node yield [LNY], and overall survival [OS]), and perioperative morbidity (length of stay [LOS] and readmission) as appropriate.

      Results

      We identified 776 patients that underwent adrenalectomy for ACC, of which 307 underwent MIA. We noted patients with larger tumors (OR 0.82, 95% CI 0.78-0.86, P < .001) were less likely to have MIA prior to IPTW. We did not appreciate a significant association of MIA with cumulative treatment burden or the use of any adjuvant therapy (OR 0.85, 95% CI 0.60-1.21, P = .375), adjuvant RT (OR 0.94, 95% CI 0.59-1.50, P = .801), or adjuvant systemic therapy (OR 0.84, 95% CI 0.58-1.21, P = .352). Patients undergoing MIA had similar oncological effectiveness of surgery and OS when compared with patients which underwent OA. Patients that underwent MIA had a significantly shorter LOS (IRR: 0.74, 95% CI 0.62-0.88, P = .001) and lower odds of readmission (OR 0.46, 95% CI 0.23-0.91, P = .026).

      Conclusions

      Although the standard of care for adrenal lesions suspicious for ACC remains OA, in appropriately selected patients, MIA may offer similar oncological effectiveness and cumulative treatment burden, with less morbidity, than OA.

      Keywords

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      References

        • Rodgers S.E.
        • Evans D.B.
        • Lee J.E.
        • et al.
        Adrenocortical carcinoma.
        Surg Oncol Clin N Am. 2006; 15: 535-553
        • Shah M.H.
        • Goldner W.S.
        • Halfdanarson T.R.
        • et al.
        NCCN Guidelines Insights: Neuroendocrine and Adrenal Tumors, Version 2.2018.
        J Natl Compr Canc Netw. 2018; 16: 693
        • Fassnacht M.
        • Dekkers O.M.
        • Else T.
        • et al.
        European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors.
        Eur J Endocrinol. 2018; 179: G1
        • Miller B.S.
        • Gauger P.G.
        • Hammer G.D.
        • et al.
        Resection of adrenocortical carcinoma is less complete and local recurrence occurs sooner and more often after laparoscopic adrenalectomy than after open adrenalectomy.
        Surgery. 2012; 152: 1150
        • Huynh K.T.
        • Lee D.Y.
        • Lau B.J.
        • et al.
        Impact of laparoscopic adrenalectomy on overall survival in patients with nonmetastatic adrenocortical carcinoma.
        J Am Coll Surg. 2016; 223: 485
        • Payabyab E.C.
        • Balasubramaniam S.
        • Edgerly M.
        • et al.
        Adrenocortical cancer: a molecularly complex disease where surgery matters.
        Clin Cancer Res. 2016; 22: 4989
        • Miller B.S.
        • Ammori J.B.
        • Gauger P.G.
        • et al.
        Laparoscopic resection is inappropriate in patients with known or suspected adrenocortical carcinoma.
        World J Surg. 2010; 34: 1380
        • Margonis G.A.
        • Kim Y.
        • Prescott J.D.
        • et al.
        Adrenocortical carcinoma: impact of surgical margin status on long-term outcomes.
        Ann Surg Oncol. 2016; 23: 134
        • Bedrose S.
        • Daher M.
        • Altameemi L.
        • et al.
        Adjuvant Therapy in Adrenocortical Carcinoma: Reflections and Future Directions.
        Cancers (Basel). 2020; 12: 508
        • Anderson Jr., K.L.
        • Adam M.A.
        • Thomas S.M.
        • et al.
        Impact of micro- and macroscopically positive surgical margins on survival after resection of adrenocortical carcinoma.
        Ann Surg Oncol. 2018; 25: 1425
        • Ayala-Ramirez M.
        • Jasim S.
        • Feng L.
        • et al.
        Adrenocortical carcinoma: clinical outcomes and prognosis of 330 patients at a tertiary care center.
        Eur J Endocrinol. 2013; 169: 891
        • Maurice M.J.
        • Bream M.J.
        • Kim S.P.
        • et al.
        Surgical quality of minimally invasive adrenalectomy for adrenocortical carcinoma: a contemporary analysis using the National Cancer Database.
        BJU Int. 2017; 119: 436
        • Hu X.
        • Yang W.X.
        • Shao Y.X.
        • et al.
        Minimally invasive versus open adrenalectomy in patients with adrenocortical carcinoma: a meta-analysis.
        Ann Surg Oncol. 2020; 27: 3858
        • Mohanty S.
        • Bilimoria K.Y.
        Comparing national cancer registries: the National Cancer Data Base (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) program.
        J Surg Oncol. 2014; 109: 629
        • Merkow R.P.
        • Rademaker A.W.
        • Bilimoria K.Y.
        Practical guide to surgical data sets: National Cancer Database (NCDB).
        JAMA Surg. 2018; 153: 850
        • Bilimoria K.Y.
        • Stewart A.K.
        • Winchester D.P.
        • et al.
        The National Cancer Data Base: a powerful initiative to improve cancer care in the United States.
        Ann Surg Oncol. 2008; 15: 683
        • Boffa D.J.
        • Rosen J.E.
        • Mallin K.
        • et al.
        Using the National Cancer Database for Outcomes Research: a review.
        JAMA Oncol. 2017; 3: 1722
        • Zografos G.N.
        • Vasiliadis G.
        • Farfaras A.N.
        • et al.
        Laparoscopic surgery for malignant adrenal tumors.
        JSLS. 2009; 13: 196
        • Austin P.C.
        Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research.
        Commun Stats Simult Comput. 2009; 38: 1228
        • Porpiglia F.
        • Fiori C.
        • Daffara F.
        • et al.
        Retrospective evaluation of the outcome of open versus laparoscopic adrenalectomy for stage I and II adrenocortical cancer.
        Eur Urol. 2010; 57: 873
        • Brix D.
        • Allolio B.
        • Fenske W.
        • et al.
        Laparoscopic versus open adrenalectomy for adrenocortical carcinoma: surgical and oncologic outcome in 152 patients.
        Eur Urol. 2010; 58: 609
        • Cooper A.B.
        • Habra M.A.
        • Grubbs E.G.
        • et al.
        Does laparoscopic adrenalectomy jeopardize oncologic outcomes for patients with adrenocortical carcinoma?.
        Surg Endosc. 2013; 27: 4026
        • Elfenbein D.M.
        • Scarborough J.E.
        • Speicher P.J.
        • et al.
        Comparison of laparoscopic versus open adrenalectomy: results from American College of Surgeons-National Surgery Quality Improvement Project.
        J Surg Res. 2013; 184: 216
        • Faiena I.
        • Tabakin A.
        • Leow J.
        • et al.
        Adrenalectomy for benign and malignant disease: utilization and outcomes by surgeon specialty and surgical approach from 2003-2013.
        Can J Urol. 2017; 24: 8990