Laparoscopic versus open surgery in stage I-III adrenocortical carcinoma -- a retrospective comparison of 32 patients.

Laparoscopic surgery (LS) for resectable adrenocortical carcinoma (ACC) has been questioned due to uncertainty with regard to long-term oncological outcome. We analyzed the experience with LS compared to open surgery (OS) at Oslo University Hospital (OUH). Material and methods. Between 1998 and 2011 32 patients were identified with ACC stage I-III operated either by LS (17 patients) or OS (15 patients). Patients' records were reviewed retrospectively with regard to pre- and intraoperative findings, short-term surgical outcome, relapse and survival. The patients in the LS group had significantly smaller tumors and higher body mass index, otherwise the groups did not differ significantly. Thirty-one patients had been operated at surgical departments of the OUH, and all had been followed at OUH. Results. Short-term outcome favored LS by significantly shorter operation time, lower blood loss and need for transfusions, fewer postoperative complications and shorter hospitalization. The completeness of resection was similar in both groups with R0 resection accomplished in 12 patients in the LS group and 12 in the OS group. Twelve and 15 patients have relapsed in the LS and OS groups, respectively, with a similar pattern of relapse (local, peritoneal or distant). Median progression-free survival (15.2 months for LS vs. 8.1 months for OS) and median overall survival (103.6 months for LS vs. 36.5 months for OS) were not significantly different. Discussion. LS seems to offer short-term advantages and similar long-term outcome compared to OS in patients with resectable ACC stage I-III.