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Minimally invasive versus open adrenalectomy for adrenocortical carcinoma: the keys surgical factors influencing the outcomes—a collective overview

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Abstract

Purpose

Adrenocortical carcinoma (A.C.C.) is a rare tumour, often discovered at an advanced stage and associated with a poor prognosis. Surgery is the treatment of choice. We aimed to review the different surgical approaches trying to compare their outcome.

Methods

This comprehensive review has been carried out according to the PRISMA statement. The literature search was performed in PubMed, Scopus, the Cochrane Library and Google Scholar.

Results

Among all studies identified, 18 were selected for the review. A total of 14,600 patients were included in the studies, of whom 4421 were treated by mini-invasive surgery (M.I.S.). Ten studies reported 531 conversions from M.I.S. to an open approach (OA) (12%). Differences were reported for operative times as well as for postoperative complications more often in favour of OA, whereas differences for hospitalization time in favour of M.I.S.

Some studies showed an R0 resection rate from 77 to 89% for A.C.C. treated by OA and 67 to 85% for tumours treated by M.I.S. The overall recurrence rate ranged from 24 to 29% for A.C.C. treated by OA and from 26 to 36% for tumours treated by M.I.S.

Conclusions

OA should still be considered the standard surgical management of A.C.C. Laparoscopic adrenalectomy has shown shorter hospital stays and faster recovery compared to open surgery. However, the laparoscopic approach resulted in the worst recurrence rate, time to recurrence and cancer-specific mortality in stages I–III ACC. The robotic approach had similar complications rate and hospital stays, but there are still scarce results about oncologic follow-up.

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Authors and Affiliations

  1. Department of Surgery, General Surgery unit, S. Stefano Hospital, Azienda ASL Toscana Centro, Suor Niccolina Infermiera 20/22, 59100, Prato, Italy

    Alessio Giordano & Francesco Feroci

  2. Department of Surgery, General Surgery Unit, University Hospital of Cagliari, Cagliari, Italy

    Mauro Podda

  3. General Surgery Unit, ASST Spedali Civili Di Brescia, Montichiari, Italy

    Emanuele Botteri & Nereo Vettoretto

  4. Department of General Surgery, Università Politecnica Delle Marche, Ancona, Italy

    Monica Ortenzi & Mario Guerrieri

  5. Department of General Surgery, Ulss2 Marca Trevigiana, Vittorio Veneto, Italy

    Giulia Montori & Ferdinando Agresta

  6. Department of Emergency, Emergency General Surgery Unit, AOU Careggi, Firenze, Italy

    Carlo Bergamini

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  1. Alessio Giordano
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All authors contributed equally to this work. Alessio Giordano and Carlo Bergamini collected all the records and supervised the drafting of the article.

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Correspondence to Alessio Giordano.

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Giordano, A., Feroci, F., Podda, M. et al. Minimally invasive versus open adrenalectomy for adrenocortical carcinoma: the keys surgical factors influencing the outcomes—a collective overview. Langenbecks Arch Surg 408, 256 (2023). https://doi.org/10.1007/s00423-023-02997-z

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