{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T19:05:49Z","timestamp":1765307149295,"version":"3.46.0"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T00:00:00Z","timestamp":1764374400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T00:00:00Z","timestamp":1765238400000},"content-version":"vor","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Private Universit\u00e4t Witten\/Herdecke gGmbH"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Langenbecks Arch Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Investigating the role of posterior retroperitoneoscopic adrenalectomy (PRA) for the treatment of adrenocortical cancer (ACC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between January 2010 and December 2024, 28 patients (9 men, 19 female) with am mean age of 51.5\u2009\u00b1\u200919.5 years (range: 1.6\u201382.3) underwent PRA for primary ACC. Tumor sizes ranged between 3 and 15\u00a0cm (mean: 7.3\u00a0cm). Hormonal hypersecretion was found in 12 patients. Surgeries were performed in a standardized 3-port technique in prone position. Follow-up (mean: 37.9 months) data could be obtained for 26 patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 12 right and 16 left adrenalectomies. The mean operating time was 159.2\u2009\u00b1\u2009100.9\u00a0min (range: 35\u2013340\u00a0min). Seven conversions occurred (25%): five to an open approach and two to a laparoscopic approach. One patient with Cushing\u2018s syndrome died because of multiple organ failure in the postoperative period (4%). The mean follow-up time was 38.8\u2009\u00b1\u200935.3 months. Patients with stage I disease demonstrated a 5-year overall survival rate of 100%, whereas patients with stage II and III disease had 3-years survival rates of 64% and 50%, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The posterior retroperitoneoscopic approach appears feasible in patient with confirmed or suspected ACC and can be proposed in selected cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00423-025-03919-x","type":"journal-article","created":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T21:25:44Z","timestamp":1764451544000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Posterior retroperitoneoscopic adrenalectomy (PRA) in adrenocortical carcinoma (ACC)"],"prefix":"10.1007","volume":"411","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8508-9934","authenticated-orcid":false,"given":"Pier Francesco","family":"Alesina","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Polina","family":"Knyazeva","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin K.","family":"Walz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,11,29]]},"reference":[{"issue":"11","key":"3919_CR1","doi-asserted-by":"publisher","first-page":"2579","DOI":"10.1016\/j.ejca.2013.02.034","volume":"49","author":"TM Kerkhofs","year":"2013","unstructured":"Kerkhofs TM, Verhoeven RH, Van der Zwan JM, Dieleman J, Kerstens MN, Links TP, Van de Poll-Franse LV, Haak HR (2013) Adrenocortical carcinoma: a population-based study on incidence and survival in the Netherlands since 1993. Eur J Cancer (Oxford England: 1990) 49(11):2579\u20132586. https:\/\/doi.org\/10.1016\/j.ejca.2013.02.034","journal-title":"Eur J Cancer (Oxford England: 1990)"},{"key":"3919_CR2","doi-asserted-by":"publisher","unstructured":"Puglisi S, Calabrese A, Ferra\u00f9 F, Violi MA, Lagan\u00e0 M, Grisanti S, Ceccato F, Scaroni C, Dalmazi GD, Stigliano A, Altieri B, Canu L, Loli P, Pivonello R, Arvat E, Morelli V, Perotti P, Basile V, Berchialla P, Urru S, Terzolo M (2023) New findings on presentation and outcome of patients with adrenocortical cancer: results from a national cohort study. J Clin Endocrinol Metab. https:\/\/doi.org\/10.1210\/clinem\/dgad199","DOI":"10.1210\/clinem\/dgad199"},{"issue":"4","key":"3919_CR3","doi-asserted-by":"publisher","first-page":"G1","DOI":"10.1530\/EJE-18-0608","volume":"179","author":"M Fassnacht","year":"2018","unstructured":"Fassnacht M, Dekkers OM, Else T, Baudin E, Berruti A, de Krijger R, Haak HR, Mihai R, Assie G, Terzolo M (2018) European society of endocrinology clinical practice guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European network for the study of adrenal tumors. Eur J Endocrinol 179(4):G1\u2013G46. https:\/\/doi.org\/10.1530\/EJE-18-0608","journal-title":"Eur J Endocrinol"},{"issue":"4","key":"3919_CR4","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1016\/j.eururo.2010.06.024","volume":"58","author":"D Brix","year":"2010","unstructured":"Brix D, Allolio B, Fenske W, Agha A, Dralle H, Jurowich C, Langer P, Mussack T, Nies C, Riedmiller H, Spahn M, Weismann D, Hahner S, Fassnacht M, German Adrenocortical Carcinoma Registry Group (2010) Laparoscopic versus open adrenalectomy for adrenocortical carcinoma: surgical and oncologic outcome in 152 patients. Eur Urol 58(4):609\u2013615. https:\/\/doi.org\/10.1016\/j.eururo.2010.06.024","journal-title":"Eur Urol"},{"issue":"5","key":"3919_CR5","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1016\/j.eururo.2010.01.036","volume":"57","author":"F Porpiglia","year":"2010","unstructured":"Porpiglia F, Fiori C, Daffara F, Zaggia B, Bollito E, Volante M, Berruti A, Terzolo M (2010) Retrospective evaluation of the outcome of open versus laparoscopic adrenalectomy for stage I and II adrenocortical cancer. Eur Urol 57(5):873\u2013878. https:\/\/doi.org\/10.1016\/j.eururo.2010.01.036","journal-title":"Eur Urol"},{"issue":"1","key":"3919_CR6","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1007\/s00423-023-02997-z","volume":"408","author":"A Giordano","year":"2023","unstructured":"Giordano A, Feroci F, Podda M, Botteri E, Ortenzi M, Montori G, Guerrieri M, Vettoretto N, Agresta F, Bergamini C (2023) Minimally invasive versus open adrenalectomy for adrenocortical carcinoma: the keys surgical factors influencing the outcomes-a collective overview. Langenbecks Arch Surg 408(1):256. https:\/\/doi.org\/10.1007\/s00423-023-02997-z","journal-title":"Langenbecks Arch Surg"},{"issue":"1","key":"3919_CR7","first-page":"53","volume":"120","author":"MK Walz","year":"1995","unstructured":"Walz MK, Peitgen K, Krause U, Eigler FW (1995) Die dorsale Retroperitoneoskopische Adrenalektomie\u2013eine neue operative technik [Dorsal retroperitoneoscopic adrenalectomy\u2013a new surgical technique]. Zentralbl Chir 120(1):53\u201358","journal-title":"Zentralbl Chir"},{"issue":"6","key":"3919_CR8","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1016\/j.surg.2006.07.039","volume":"140","author":"MK Walz","year":"2006","unstructured":"Walz MK, Alesina PF, Wenger FA, Deligiannis A, Szuczik E, Petersenn S, Ommer A, Groeben H, Peitgen K, Janssen OE, Philipp T, Neumann HP, Schmid KW, Mann K (2006) Posterior retroperitoneoscopic adrenalectomy\u2013results of 560 procedures in 520 patients. Surgery 140(6):943\u2013950. https:\/\/doi.org\/10.1016\/j.surg.2006.07.039","journal-title":"Surgery"},{"issue":"3","key":"3919_CR9","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1007\/s00423-008-0418-z","volume":"394","author":"MK Walz","year":"2009","unstructured":"Walz MK, Alesina PF (2009) Single access retroperitoneoscopic adrenalectomy (SARA) - one step beyond in endocrine surgery. Langenbecks Arch Surg 394(3):447\u2013450. https:\/\/doi.org\/10.1007\/s00423-008-0418-z","journal-title":"Langenbecks Arch Surg"},{"issue":"1","key":"3919_CR10","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1245\/s10434-020-08824-9","volume":"28","author":"OM Delozier","year":"2021","unstructured":"Delozier OM, Stiles ZE, Deschner BW, Drake JA, Deneve JL, Glazer ES, Tsao MW, Yakoub D, Dickson PV (2021) Implications of conversion during attempted minimally invasive adrenalectomy for adrenocortical carcinoma. Ann Surg Oncol 28(1):492\u2013501. https:\/\/doi.org\/10.1245\/s10434-020-08824-9","journal-title":"Ann Surg Oncol"},{"issue":"1","key":"3919_CR11","first-page":"1","volume":"183","author":"LM Brunt","year":"1996","unstructured":"Brunt LM, Doherty GM, Norton JA, Soper NJ, Quasebarth MA, Moley JF (1996) Laparoscopic adrenalectomy compared to open adrenalectomy for benign adrenal neoplasms. J Am Coll Surg 183(1):1\u201310","journal-title":"J Am Coll Surg"},{"issue":"1","key":"3919_CR12","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1245\/s10434-013-3164-6","volume":"21","author":"G Donatini","year":"2014","unstructured":"Donatini G, Caiazzo R, Do Cao C, Aubert S, Zerrweck C, El-Kathib Z, Gauthier T, Leteurtre E, Wemeau JL, Vantyghem MC, Carnaille B, Pattou F (2014) Long-term survival after adrenalectomy for stage I\/II adrenocortical carcinoma (ACC): a retrospective comparative cohort study of laparoscopic versus open approach. Ann Surg Oncol 21(1):284\u2013291. https:\/\/doi.org\/10.1245\/s10434-013-3164-6","journal-title":"Ann Surg Oncol"},{"issue":"11","key":"3919_CR13","doi-asserted-by":"publisher","first-page":"3698","DOI":"10.3390\/jcm12113698","volume":"12","author":"M Gaillard","year":"2023","unstructured":"Gaillard M, Razafinimanana M, Challine A, Araujo RLC, Lib\u00e9 R, Sibony M, Barat M, Bertherat J, Dousset B, Fuks D, Gaujoux S (2023) Laparoscopic or open adrenalectomy for stage I-II adrenocortical carcinoma: a retrospective study. J Clin Med 12(11):3698. https:\/\/doi.org\/10.3390\/jcm12113698","journal-title":"J Clin Med"},{"issue":"6","key":"3919_CR14","doi-asserted-by":"publisher","first-page":"1325","DOI":"10.1016\/j.surg.2018.07.026","volume":"164","author":"K Wu","year":"2018","unstructured":"Wu K, Liu Z, Liang J, Tang Y, Zou Z, Zhou C, Zhang F, Lu Y (2018) Laparoscopic versus open adrenalectomy for localized (stage 1\/2) adrenocortical carcinoma: experience at a single, high-volumecenter. Surgery 164(6):1325\u20131329. https:\/\/doi.org\/10.1016\/j.surg.2018.07.026","journal-title":"Surgery"},{"issue":"6","key":"3919_CR15","doi-asserted-by":"publisher","first-page":"1380","DOI":"10.1007\/s00268-010-0532-2","volume":"34","author":"BS Miller","year":"2010","unstructured":"Miller BS, Ammori JB, Gauger PG, Broome JT, Hammer GD, Doherty GM (2010) Laparoscopic resection is inappropriate in patients with known or suspected adrenocortical carcinoma. World J Surg 34(6):1380\u20131385. https:\/\/doi.org\/10.1007\/s00268-010-0532-2","journal-title":"World J Surg"},{"issue":"7","key":"3919_CR16","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1007\/s00268-001-0047-y","volume":"25","author":"P Icard","year":"2001","unstructured":"Icard P, Goudet P, Charpenay C, Andreassian B, Carnaille B, Chapuis Y, Cougard P, Henry JF, Proye C (2001) Adrenocortical carcinomas: surgical trends and results of a 253-patient series from the French association of endocrine surgeons study group. World J Surg 25(7):891\u2013897. https:\/\/doi.org\/10.1007\/s00268-001-0047-y","journal-title":"World J Surg"},{"issue":"3","key":"3919_CR17","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1007\/s00268-015-3283-2","volume":"40","author":"N Nilubol","year":"2016","unstructured":"Nilubol N, Patel D, Kebebew E (2016) Does lymphadenectomy improve survival in patients with adrenocortical carcinoma? A population-based study. World J Surg 40(3):697\u2013705. https:\/\/doi.org\/10.1007\/s00268-015-3283-2","journal-title":"World J Surg"},{"issue":"2","key":"3919_CR18","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1097\/SLA.0b013e3182367ac3","volume":"255","author":"J Reibetanz","year":"2012","unstructured":"Reibetanz J, Jurowich C, Erdogan I, Nies C, Rayes N, Dralle H, Behrend M, Allolio B, Fassnacht M, German, ACC study group (2012) Impact of lymphadenectomy on the oncologic outcome of patients with adrenocortical carcinoma. Ann Surg 255(2):363\u2013369. https:\/\/doi.org\/10.1097\/SLA.0b013e3182367ac3","journal-title":"Ann Surg"},{"issue":"2","key":"3919_CR19","doi-asserted-by":"publisher","first-page":"291","DOI":"10.3390\/cancers14020291","volume":"14","author":"A Hendricks","year":"2022","unstructured":"Hendricks A, M\u00fcller S, Fassnacht M, Germer CT, Wiegering VA, Wiegering A, Reibetanz J (2022) Impact of lymphadenectomy on the oncologic outcome of patients with adrenocortical carcinoma-a systematic review and meta-analysis. Cancers (Basel) 14(2):291. https:\/\/doi.org\/10.3390\/cancers14020291","journal-title":"Cancers (Basel)"},{"key":"3919_CR20","doi-asserted-by":"publisher","unstructured":"Walz MK, Jongekkasit I, Alesina PF (2021) Retroperitoneoscopic adrenalectomy in adrenocortical carcinoma with tumor thrombus in inferior vena cava: one step further in minimally invasive endocrine surgery. VideoEndocrinology. https:\/\/doi.org\/10.1089\/ve.2020.0202","DOI":"10.1089\/ve.2020.0202"},{"issue":"2","key":"3919_CR21","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1007\/s00423-011-0876-6","volume":"397","author":"R Mihai","year":"2012","unstructured":"Mihai R, Iacobone M, Makay O, Moreno P, Frilling A, Kraimps JL, Soriano A, Villar del Moral J, Barczynski M, Dur\u00e1n MC, Sadler GP, Niederle B, Dralle H, Harrison B, Carnaille B (2012) Outcome of operation in patients with adrenocortical cancer invading the inferior Vena cava\u2013a European society of endocrine surgeons (ESES) survey. Langenbeck\u2019s Archives Surg 397(2):225\u2013231. https:\/\/doi.org\/10.1007\/s00423-011-0876-6","journal-title":"Langenbeck\u2019s Archives Surg"},{"issue":"4","key":"3919_CR22","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1007\/s40618-015-0422-4","volume":"39","author":"F Porpiglia","year":"2016","unstructured":"Porpiglia F, Fiori C, Daffara FC, Zaggia B, Ardito A, Scarpa RM, Papotti M, Berruti A, Scagliotti GV, Terzolo M (2016) Does nephrectomy during radical adrenalectomy for stage II adrenocortical cancer affect patient outcome? J Endocrinol Invest 39(4):465\u2013471. https:\/\/doi.org\/10.1007\/s40618-015-0422-4","journal-title":"J Endocrinol Invest"},{"issue":"7","key":"3919_CR23","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1089\/lap.2018.0809","volume":"29","author":"PF Alesina","year":"2019","unstructured":"Alesina PF, Walz MK (2019) A new minimally invasive approach to the posterior right segments of the liver: report of the first two cases. J Laparoendosc Adv Surg Tech A 29(7):943\u2013948. https:\/\/doi.org\/10.1089\/lap.2018.0809","journal-title":"J Laparoendosc Adv Surg Tech A"},{"issue":"4","key":"3919_CR24","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1007\/s13193-020-01205-4","volume":"11","author":"MK Walz","year":"2020","unstructured":"Walz MK, Metz KA, Theurer S, Myland C, Alesina PF, Schmid KW (2020) Differentiating benign from malignant adrenocortical tumors by a single morphological parameter-a clinicopathological study on 837 adrenocortical neoplasias. Indian J Surg Oncol 11(4):705\u2013710. https:\/\/doi.org\/10.1007\/s13193-020-01205-4","journal-title":"Indian J Surg Oncol"}],"container-title":["Langenbeck's Archives of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00423-025-03919-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00423-025-03919-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00423-025-03919-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T19:01:59Z","timestamp":1765306919000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00423-025-03919-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,29]]},"references-count":24,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3919"],"URL":"https:\/\/doi.org\/10.1007\/s00423-025-03919-x","relation":{},"ISSN":["1435-2451"],"issn-type":[{"type":"electronic","value":"1435-2451"}],"subject":[],"published":{"date-parts":[[2025,11,29]]},"assertion":[{"value":"26 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 November 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 November 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"28"}}