{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T03:59:32Z","timestamp":1789790372253,"version":"4.0.1"},"reference-count":31,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T00:00:00Z","timestamp":1613088000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Adrenocortical carcinoma (ACC) is often a contraindication to minimally invasive adrenalectomy (MIA). We used an administrative data set to analyze postoperative outcomes. We hypothesized that small tumors would have better short\u2010 and long\u2010term outcomes, independent of the operative approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The National Cancer Database (2010\u20132016) identified patients with ACC who underwent adrenalectomy. Tumors were grouped:\u00a0&lt;5\u2009cm (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009125), 5\u201310\u2009cm (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009431), and\u00a0&gt;10\u2009cm (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009443). The primary and secondary outcomes were margin positivity and overall survival, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nine hundred and ninety\u2010nine\u00a0patients were analyzed: 37% MIA and 63% open adrenalectomy (OA). As the size increased, the rate of attempted MIA decreased. Larger tumors were associated with conversion to open. Although\u00a0tumors with local invasion and those which required conversion to open were associated with an increased likelihood of a positive margin, tumor size was not. Although \u201ccomplete\u201d MIA (vs. OA) and tumor size were not associated with differences in survival, conversion (HR\u2009=\u20091.83,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.02), positive margins (HR\u2009=\u20091.54,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.01), and local invasion (HR\u2009=\u20091.84,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001) were associated with poor survival.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Positive margins are associated with poor survival in ACC. Tumors\u2009\u2265\u20095\u2009cm were associated with an increased conversion rate and subsequent increase in margin positivity. MIA may be considered for select patients with small tumors but adequate oncologic resection is critical.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.26418","type":"journal-article","created":{"date-parts":[[2021,2,14]],"date-time":"2021-02-14T10:13:28Z","timestamp":1613297608000},"page":"1238-1245","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Reassessing the impact of tumor size on operative approach in adrenocortical carcinoma"],"prefix":"10.1002","volume":"123","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1608-8874","authenticated-orcid":false,"given":"Jonathan J.","family":"Hue","sequence":"first","affiliation":[{"name":"Department of Surgery University Hospitals Cleveland Medical Center  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Bingmer","sequence":"additional","affiliation":[{"name":"Department of Surgery University 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Hospitals Cleveland Medical Center  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke D.","family":"Rothermel","sequence":"additional","affiliation":[{"name":"Department of Surgery University Hospitals Cleveland Medical Center  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,2,12]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2018-00918"},{"key":"e_1_2_7_3_1","unstructured":"Neuroendocrine and Adrenal Tumors \u2014 NCCN Guideline.NCCN Clin Pract Guidel 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