Razlike u ishodima liječenja otvorenom i laparoskopskom adrenalektomijom kod bolesnika s lokaliziranim adrenokortikalnim karcinomom

master's thesis

• Title (english): Open vs laparoscopic adrenalectomy for localized adrenocortical carcinoma
• Author: Luka Kakarigi
• Mentor: Darko Kaštelan (mentor)
• Committee member: Tina Dušek (predsjednik povjerenstva)
• Committee member: Martina Lovrić Benčić (član povjerenstva)
• Committee member: Darko Kaštelan (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2023-05-31, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Cilj istraživanja bio je usporediti razlike u dugoročnim ishodima ljiečenja otvorenom i laparoskopskom adrenalektomijom kod bolesnika s lokaliziranim adrenokortikalnim karcinomom (ACC). Ovo retrospektivno istraživanje obuhvatilo je 46 bolesnika s ACC ENSAT stadijem I-III, od čega je 23 bilo podvrgnuto otvorenoj (OA skupina) i 23 laparoskopskoj adrenalektomiji (LA skupina). Ishodi liječenja koji su bili analizirani su preživljenje bez povratka bolesti (RFS) i ukupno preživljenje (OS) te njihove razlike među grupama bolesnika liječenih OA i LA. Bolesnici OA skupine imali su veće tumore (120 [70-250] mm naspram 75 [26-110] mm; P < 0.001), viši Ki-67 indeks (16 [1-65] % naspram 10 [1-25] %; P = 0.04) i uznapredovaliji stadij bolesti (P = 0.01) u odnosu na bolesnike LA skupine. Medijan praćenja bolesnika OA skupine bio je 51 (12-174) mjesec, a bolesnika LA skupine 53 (5-127) mjeseca. U osmero bolesnika (5 OA i 3 LA) bolest je recidivirala, a šestero bolesnika (3 OA i 3 LA) je tijekom perioda praćenja umrlo. Nisu nađene razlike u RFS i OS između OA i LA skupine. Ovo istraživanje pokazalo je kako je, po pitanju RFS i OS, LA primjerena terapijska opcija u bolesnika s lokaliziranim ACC bez invazija ekstra-adrenalnog tkiva. Ipak, naši su rezultati ograničeni na referentne centre s velikim iskustvom u liječenju bolesnika s ACC i stoga nisu nužno primjenjivi na centre koji imaju manje iskustva u liječenju ovih bolesnika.

Abstract (english)

The purpose of the study was to compare the long-term outcomes of patients with localized adrenocortical carcinoma (ACC) subjected to open vs laparoscopic surgery. This retrospective study included 46 patients with the ACC ENSAT stage I- stage III of whom 23 underwent open surgery (OA group), whereas 23 were subjected to laparoscopic adrenalectomy (LA group). The main outcomes analysed in the study were differences between the OA and LA groups in recurrence-free survival (RFS) and overall survival (OS). Patients in OA group had larger tumours (120 [70-250] mm vs 75 [26-110] mm; P < 0.001), higher Ki-67 index (16 [1-65] % vs 10 [1-25] %; P = 0.04) and higher disease stage (P = 0.01) compared with patients in the LA group. The median duration of follow-up for patients that underwent OA and LA was 51 (12-174) and 53 (5-127) months, respectively. Eight patients (5 OA and 3 LA) experienced recurrence of disease, whereas six patients (3 OA and 3 LA) died during follow-up. No differences in RFS and OS were found between patinets who underwent open or laparoscopic surgery. The study demonstrated that in patients with localized ACC and without invasion of extra-adrenal tissue, LA is a plausible treatment option in terms of RFS and OS. However, our results are limited to referral centres with large experience in management of patients with ACC and therefore may not necessarily apply to non-specialized centres.

• Keywords: adrenokortikalni karcinom; hiperfunkcija nadbubrežne žlijezde; Cushingov sindrom; preživljenje bez bolesti; laparoskopska kirurgija; mitotan; preživljenje
• Keywords (english): adrenocortical carcinoma; adrenocortical hyperfunction; Cushing's syndrome; disease-free survival; laparoscopic surgery; mitotane; survival
• Language: croatian
• URN:NBN: urn:nbn:hr:105:708872
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-10-25 09:43:17