Laparoscopic adrenalectomy for adrenocortical carcinoma: a medico-surgical perspective

Adrenocortical carcinoma (ACC) is a rare tumor carrying a dismal prognosis. The only hope for cure is a complete surgical resection. Whether this can be achieved by laparoscopic adrenalectomy (LA) remains questionable, and is now a "hot topic" for the medical and surgical community. The aim of this article was to review the result of LA for ACC in the view of the recent and highly controversial literature.

Electronic searches in MEDLINE via PubMed regarding relevant English language studies published through February 2012 were reviewed.

Initially, LA for ACC has only been reported as case report or short series. This initial experience emphasized the potential deleterious effect of LA, especially in case of tumor spillage during the procedure. Recently, larger studies comparing laparoscopic and open approach for ACC have been published. These retrospective studies reported conflicting results, either equivalent results or an increased risk of tumor spillage and peritoneal carcinomatosis, and are all limited by several bias.

Overall, no definitive answer regarding the equivalence of LA for ACC can be drawn from the available literature. Even if it is likely that for well-selected cases the same procedure performed by laparoscopic or open approach may provide equivalent results, we believe that in face of a modest benefit, the risk of tumor spillage during LA should be an important consideration. Even if it is tenting, laparoscopic approach for ACC should be avoided, at least until a clear standard of surgical care has been achieved and established for the open approach.