Robotic approach is associated with lower positive margin rates in minimally invasive adrenalectomy for adrenocortical carcinoma: A nationwide analysis

Document Type

Conference Proceeding

Publication Date

3-1-2026

Publication Title

Eur Urol

Keywords

Urology & Nephrology

Abstract

Introduction & Objectives: Minimally invasive adrenalectomy has gained popularity for the treatment of adrenocortical carcinoma (ACC), yet its oncologic adequacy remains debated. Current guidelines recommend caution or restriction to selected cases, given concerns over capsular rupture and positive surgical margins (PSM), key determinants of recurrence. We aimed to evaluate national trends and perioperative outcomes of minimally invasive adrenalectomy for ACC, focusing on the impact of surgical approach (robotic vs laparoscopic) on margin status. Materials & Methods: The National Cancer Database (2010–2022) was queried for adults with nonmetastatic ACC who underwent planned minimally invasive adrenalectomy (laparoscopic or robotic). Patients with nodal or distant disease, missing margin data, or planned open surgery were excluded. Patient, tumor, and facility characteristics were compared between approaches. Multivariable logistic regression, clustered by facility, assessed the impact of surgical approach on PSM after adjusting for age, tumor size, pathologic T stage, and facility type. Results: Among 681 patients meeting inclusion criteria, 429 (63%) underwent laparoscopic and 252 (37%) robotic adrenalectomies. Use of robotics increased substantially over time (61% in 2018–2022 vs. 10% in 2010-2013, p<0.001). No significant differences were observed between groups in terms of age, comorbidity, or tumor size (median 69 mm for laparoscopic vs. 70 mm for robotic cases, p = 0.7). Median age, comorbidity, and tumor size distributions were similar across groups. Overall, 19% of patients had positive surgical margins (PSM), occurring in 22% of laparoscopic and 15% of robotic procedures (p=0.04). In multivariable analysis, robotic approach was independently associated with lower rate of PSM (adjusted OR 0.58, 95% CI 0.36–0.94, p=0.028), after adjustment for tumor size, pathological stage, and age. Conclusions: Positive surgical margins occur in nearly one in five cases. However, robotic procedures were associated with significantly lower odds of margin positivity compared with laparoscopy, even after adjustment for tumor size and stage. These findings suggest that robotic technology may reduce some of the oncologic concerns historically associated with minimally invasive adrenalectomy for ACC and could inform future discussions regarding surgical approach selection.

Volume

89

First Page

1

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