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Adrenocortical carcinoma: which surgical approach?
1Service de Chirurgie Endocrinienne, Université Lille Nord de France, CHU, 59037, Lille, Cedex, France. bcarnaille@chru-lille.fr
Langenbeck'S Archives of Surgery
|September 28, 2011
Summary
For adrenal cortical carcinoma (ACC), laparoscopic adrenalectomy offers postoperative benefits but has mixed oncological outcomes compared to open surgery. An open approach is advised for locally invasive tumors.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Adrenal Gland Tumors
Background:
- Limited randomized trials exist comparing open versus laparoscopic adrenalectomy for adrenal cortical carcinoma (ACC).
- Existing evidence suggests postoperative benefits for patients undergoing laparoscopic adrenalectomy.
Purpose of the Study:
- To compare the oncological outcomes and patient benefits of open versus laparoscopic adrenalectomy in adrenal cortical carcinoma.
Main Methods:
- Review of existing evidence comparing open and laparoscopic adrenalectomy for ACC.
- Analysis of postoperative benefits, local recurrence, peritoneal carcinomatosis, survival, and R0 resection rates.
Main Results:
- Laparoscopic adrenalectomy shows postoperative patient benefits (Level B).
- Oncological outcomes are equivocal: increased risk of local recurrence and peritoneal carcinomatosis with laparoscopy (Level D), but identical survival and recurrence rates (Level C).
Conclusions:
- Open adrenalectomy is recommended for locally invasive ACC to achieve R0 resection (Level D).
- Laparoscopic resection may be suitable for Stage 1-2 ACC with tumors <10 cm, provided R0 resection is achieved without capsule rupture (Level C).
