Minimally invasive surgery for malignant adrenal tumors

Background: The increasingly widespread use of minimally invasive surgery has allowed surgeons to exploit this approach for malignant adrenal tumors, though its actual role remains debated. The purpose of this study was to ascertain whether minimally-invasive surgery is a safe and effective treatment for adrenal carcinoma and metastases. Methods: Demographic and clinical data were prospectively entered in a computerized endocrine surgery registry for all patients who underwent surgery for adrenal lesions at our institution over a 20-year period (1991-2010). For the purposes of the present study, the registry was queried to identify patients who had minimally-invasive surgery for adrenocortical carcinoma (group 1) or adrenal metastases (group 2). Results: Out of 332 patients undergoing adrenalectomy 25 were operated on for adrenal malignancies: 9 (group 1) had primary adrenal carcinomas and 16 (group 2) had adrenal metastases. Successfully laparoscopic adrenalectomy was performed in 16.6% (1/6) and in 93.3% (14/15) of group 1 and group 2, respectively. The mean operating time was 140 min (range 70-280 min) and 80 mm (range 50-180 min) for groups 1 and 2, respectively. The median survival for group 1 was 30 months and Kaplan-Meier life table analysis showed a survival rate of 89%, 25.4% and 12.7% at 1, 3 and 5 years, respectively. The median survival for group 2 was 28 months and Kaplan-Meier life table analysis identified survival rates of 94%, 20.1% and 6.7% at 1, 3 and 5 years, respectively. Conclusions: This study shows that laparoscopic resection is inappropriate for patients with known or suspected adrenocortical carcinoma, while the laparoscopic approach can be justified and is feasible in case of adrenal metastases. (C) 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.