{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T11:22:33Z","timestamp":1788348153042,"version":"build-2803163510"},"reference-count":32,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2016,9,1]],"date-time":"2016-09-01T00:00:00Z","timestamp":1472688000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2017,3]]},"abstract":"\n Objectives<\/jats:title>\n \n To compare quality outcomes between open (\n OA<\/jats:styled-content>\n ) and minimally invasive (\n MIA<\/jats:styled-content>\n ) adrenalectomy for adrenocortical carcinoma (\n ACC<\/jats:styled-content>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Patients and Methods<\/jats:title>\n \n In the National Cancer Database, we identified 481 patients with non\u2010metastatic\n ACC<\/jats:styled-content>\n who underwent adrenalectomy from 2010 to 2013.\n OA<\/jats:styled-content>\n and\n MIA<\/jats:styled-content>\n were compared on positive surgical margin (\n PSM<\/jats:styled-content>\n ) and lymph node dissection (\n LND<\/jats:styled-content>\n ) rates (primary outcomes), and lymph node yield, length of stay (\n LOS<\/jats:styled-content>\n ), readmission, and overall survival (secondary outcomes). Using the intention\u2010to\u2010treat principle, minimally\u2010invasive\u2010converted\u2010to\u2010open cases were considered\n MIA<\/jats:styled-content>\n . Logistic regression analysis was used to identify predictors of\n PSM<\/jats:styled-content>\n s and\n LND<\/jats:styled-content>\n . Associations between approach and the outcomes were further assessed by stage and tumour size.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Overall, 161 patients (33.5%) underwent\n MIA<\/jats:styled-content>\n .\n MIA<\/jats:styled-content>\n was used more commonly in older, comorbid patients; for smaller, localised tumours; and at lower\u2010volume centres. In the intention\u2010to\u2010treat analysis,\n MIA<\/jats:styled-content>\n independently predicted\n PSM<\/jats:styled-content>\n s [odds ratio (\n OR<\/jats:styled-content>\n ) 2.0, 95% confidence interval (\n CI<\/jats:styled-content>\n ) 1.1\u20133.6;\n P<\/jats:italic>\n = 0.03) and no\n LND<\/jats:styled-content>\n (\n OR<\/jats:styled-content>\n 0.1, 95%\n CI<\/jats:styled-content>\n 0.03\u20130.6;\n P<\/jats:italic>\n = 0.01). On subgroup analysis, the association between\n MIA<\/jats:styled-content>\n and\n PSM<\/jats:styled-content>\n s only held true for\n pT<\/jats:styled-content>\n 3 disease (48.7% vs 26.7%,\n P<\/jats:italic>\n = 0.01). A higher\n PSM<\/jats:styled-content>\n rate was seen for tumours of \u226510 cm managed with\n MIA<\/jats:styled-content>\n vs\n OA<\/jats:styled-content>\n , but this difference was not significant (28.2% vs 18.5%,\n P<\/jats:italic>\n = 0.16). Likewise, the association between\n MIA<\/jats:styled-content>\n and no\n LND<\/jats:styled-content>\n was only observed for male patients, tumours \u226510 cm, and\n cN<\/jats:styled-content>\n 0 disease. After excluding minimally\u2010invasive\u2010converted\u2010to\u2010open cases, the difference in\n PSM<\/jats:styled-content>\n was less pronounced and non\u2010significant (\n OR<\/jats:styled-content>\n 1.8, 95%\n CI<\/jats:styled-content>\n 0.9\u20133.4;\n P<\/jats:italic>\n = 0.08).\n MIA<\/jats:styled-content>\n was associated with significantly shorter median\n LOS<\/jats:styled-content>\n (3 vs 6 days,\n P<\/jats:italic>\n < 0.01) and non\u2010significantly decreased readmissions (4.4% vs 8.8%,\n P<\/jats:italic>\n = 0.08) compared to\n OA<\/jats:styled-content>\n without any difference in lymph node yield or overall survival.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n For organ\u2010confined disease,\n MIA<\/jats:styled-content>\n offers comparable surgical quality to\n OA<\/jats:styled-content>\n , while expediting inpatient recovery.\n OA<\/jats:styled-content>\n is associated with superior outcomes for locally advanced disease.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/bju.13618","type":"journal-article","created":{"date-parts":[[2016,8,4]],"date-time":"2016-08-04T02:24:37Z","timestamp":1470277477000},"page":"436-443","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Surgical quality of minimally invasive adrenalectomy for adrenocortical carcinoma: a contemporary analysis using the National Cancer Database"],"prefix":"10.1111","volume":"119","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0324-8795","authenticated-orcid":false,"given":"Matthew J.","family":"Maurice","sequence":"first","affiliation":[{"name":"Department of Urology Glickman Urological and Kidney Institute Cleveland Clinic Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Bream","sequence":"additional","affiliation":[{"name":"Urology Institute University Hospitals Case Medical Center Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon P.","family":"Kim","sequence":"additional","affiliation":[{"name":"Urology Institute University Hospitals Case Medical Center Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Abouassaly","sequence":"additional","affiliation":[{"name":"Urology Institute University Hospitals Case Medical Center Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,9]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-005-0329-x"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.23886"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10434-999-0719-7"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/000313481307901033"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2011.09.030"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00345\u2010016\u20101791\u20109"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mds231"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-011-0852-1"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-013-3169-z"},{"key":"e_1_2_11_11_1","unstructured":"National Comprehensive Cancer Network.NCCN Clinical Practice Guidelines in Oncology: Neuroendocrine Tumors Version I.2015. 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