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Surgical quality of minimally invasive adrenalectomy for adrenocortical carcinoma: a contemporary analysis using the National Cancer Database
Author(s) -
Maurice Matthew J.,
Bream Matthew J.,
Kim Simon P.,
Abouassaly Robert
Publication year - 2017
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13618
Subject(s) - medicine , adrenocortical carcinoma , adrenalectomy , odds ratio , confidence interval , lymph node , dissection (medical) , subgroup analysis , carcinoma , cancer , surgery , database , urology , oncology , computer science
Objectives To compare quality outcomes between open ( OA ) and minimally invasive ( MIA ) adrenalectomy for adrenocortical carcinoma ( ACC ). Patients and Methods In the National Cancer Database, we identified 481 patients with non‐metastatic ACC who underwent adrenalectomy from 2010 to 2013. OA and MIA were compared on positive surgical margin ( PSM ) and lymph node dissection ( LND ) rates (primary outcomes), and lymph node yield, length of stay ( LOS ), readmission, and overall survival (secondary outcomes). Using the intention‐to‐treat principle, minimally‐invasive‐converted‐to‐open cases were considered MIA . Logistic regression analysis was used to identify predictors of PSM s and LND . Associations between approach and the outcomes were further assessed by stage and tumour size. Results Overall, 161 patients (33.5%) underwent MIA . MIA was used more commonly in older, comorbid patients; for smaller, localised tumours; and at lower‐volume centres. In the intention‐to‐treat analysis, MIA independently predicted PSM s [odds ratio ( OR ) 2.0, 95% confidence interval ( CI ) 1.1–3.6; P = 0.03) and no LND ( OR 0.1, 95% CI 0.03–0.6; P = 0.01). On subgroup analysis, the association between MIA and PSM s only held true for pT 3 disease (48.7% vs 26.7%, P = 0.01). A higher PSM rate was seen for tumours of ≥10 cm managed with MIA vs OA , but this difference was not significant (28.2% vs 18.5%, P = 0.16). Likewise, the association between MIA and no LND was only observed for male patients, tumours ≥10 cm, and cN 0 disease. After excluding minimally‐invasive‐converted‐to‐open cases, the difference in PSM was less pronounced and non‐significant ( OR 1.8, 95% CI 0.9–3.4; P = 0.08). MIA was associated with significantly shorter median LOS (3 vs 6 days, P < 0.01) and non‐significantly decreased readmissions (4.4% vs 8.8%, P = 0.08) compared to OA without any difference in lymph node yield or overall survival. Conclusion 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.