On the issue of adrenalectomy using videoendoscopic approaches in adrenocortical cancer

Objective. To evaluate the results of adrenalectomies which were performed using endoscopic approach in surgical treatment of adrenocortical cancer.

Materials and methods. The results of surgical treatment of 58 patients with stage I-III adrenocortical cancer were studied from 1998 to 2024. A single-center retrospective controlled cohort study was conducted. The main group consisted of 23 patients who underwent adrenalectomy using video endoscopic access. Intra- and postoperative complications, disease-free and overall survival rates of patients were studied. The comparison group included 35 patients whose surgical treatment was performed via the traditional "open" approach.

Results. The median tumor size in patients of the main group was 4.8 cm [3.7; 6.1], and the maximum tumor size was 13 cm. In the comparison group, these parameters were 8 cm [6; 12] and 19 cm. There were neither intraoperative complications, nor cases of tumor capsule integrity disruption in both groups. While analyzing postoperative complications, grade I complications according to the Clavien-Dindo classification were revealed in 2 patients of the main group. In the comparison group 4 patients had grade I complications, 1 patient had grade IIIb complication, and grade V complication developed in 1 case. Morphological examination confirmed the resection status of R0 in all patients. In the study group, the median Weiss index was 4 [4; 5] points, and the median Ki67 expression level was 12% [7; 19.5]. In the comparison group, these indicators were higher – 6 [5; 6] points and 22% [11.5; 26]. The 5-year disease-free survival rate in the main group was 77 %, the overall 5-year survival rate was 83 %, and in the "open" surgery group, long-term outcomes were significantly worse: 51% (p=0.046) and 64% (p=0.037), respectively.

Conclusions. Video-endoscopic surgery can be considered as an effective method of treatment for patients with adrenocortical cancer, if there is no invasion into adjacent organs or regional lymph nodes metastases (in stage T1-3N0M0 according to ENSAT). Moreover, the tumor size in these cases is not a crucial factor when selecting the surgical approach. The absence of non-radical resections, satisfactory immediate results, favorable survival rates in patients of the study group with tumors more than 6 cm in size, confirmed this fact.