A debate on laparoscopic versus open adrenalectomy for adrenocortical carcinoma

Adrenocortical cancer (ACC) is a rare disease that is difficult to treat. Surgery remains the primary treatment modality and the only chance for cure in these patients. Since the early 1990s, laparoscopic adrenalectomy (LA) has replaced open adrenalectomy (OA) as the gold standard for addressing adrenal disorders of benign origin; however, the oncologic effectiveness of laparoscopic adrenalectomy for resection of primary adrenocortical malignancies remains unclear. Since the initial consensus statement from the International Adrenal Cancer Symposium held in Ann Arbor, MI in 2003, a number of studies have investigated the question of equivalence of LA compared to OA for ACC. Several controversial topics were debated during the 3rd International Adrenal Cancer Symposium held in Wurzburg, Germany in 2011. This debate sought to review the advantages and disadvantages of OA versus LA and review findings of recent studies related to the topic. As all studies involving this topic have methodological flaws, some more than others, the results of each study must be interpreted with caution. In conclusion, this debate will undoubtedly continue well into the future; however, it is clear that an oncologically appropriate surgical resection is of the utmost importance for the treatment of ACC and there is only one chance to achieve this. Poor outcomes will result from inadequate surgery, whether performed by an open or laparoscopic approach. Therefore, there is no doubt that surgery for suspected ACC should only be performed in specialized centers.