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Open Versus Laparoscopic Surgery in the Management of Adrenocortical Carcinoma: A Systematic Review and Meta-analysis

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Laparoscopic surgery is considered a standard treatment for benign adrenal tumors; however, no consensus has been reached on the optimal resection technique for adrenocortical carcinomas. This study aims to evaluate the safety and efficacy of laparoscopic surgery and open surgery in the management of adrenocortical carcinoma.

Methods

The Cochrane, Embase, PubMed, Scopus, and Web of Science databases were searched for articles from inception to May 2022, by two independent reviewers using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. The review was registered prospectively on the PROSPERO database (CRD42022316050).

Results

From 183 studies screened, 11 studies met the eligibility criteria, with a total of 1617 patients with adrenocortical carcinoma undergoing either laparoscopic surgery (n = 472) or open surgery (n = 1145). Open surgery demonstrated a lower rate of positive resection margin compared with laparoscopic surgery (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.10–2.10; I2 = 0%). Additionally, open surgery had more favorable overall survival (OR 0.56, 95% CI 0.44–0.72; I2 = 0%) and recurrence-free rates (OR 0.60, 95% CI 0.42–0.85; I2 = 38%) than laparoscopic surgery at 3 years. Hospital stay was shorter for laparoscopic surgery than open surgery (mean difference − 2.49 days, 95% CI − 2.95 to − 2.04; I2 = 45%).

Conclusions

Open surgery should still be considered the standard operative approach; however, laparoscopic surgery could be regarded as an effective and safe operation for selected adrenocortical carcinoma cases with appropriate laparoscopic expertise. Further randomized controlled studies with tumor stage- and resection margin-dependent survival analysis are necessary to ascertain the safety and efficacy of the treatment.

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Data Availability

The data set used for this meta-analysis will be shared upon request to the study authors.

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Acknowledgment

The authors would like to thank M.L.S. Larry Prokop for the literature search.

Funding

This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. St George’s University of London, London, UK

    Hayato Nakanishi MSc, Shahid Miangul BSc, Joe El Haddad BSc, Nour El Ghazal BSc, Fatma A. Abdulsalam BSc, Reem H. Matar BSc & Christian A. Than PhD

  2. University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus

    Hayato Nakanishi MSc, Shahid Miangul BSc, Joe El Haddad BSc, Nour El Ghazal BSc, Fatma A. Abdulsalam BSc, Reem H. Matar BSc & Christian A. Than PhD

  3. Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA

    Rongzhi Wang MD & Herbert Chen MD

  4. Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Reem H. Matar BSc

  5. School of Biomedical Sciences, The University of Queensland, St Lucia, QLD, Australia

    Christian A. Than PhD

  6. Division of Surgery, NorthShore University Health System, Chicago, IL, USA

    Benjamin E. Johnson MD

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Contributions

HN, SM, and HC conceived and designed the study; reviewed the literature; collected, analyzed, and interpreted the data; and drafted and critically revised the manuscript. HN, SM, RW, JEH, NEG, FAA, RHM, CAT, BEJ, and HC reviewed the literature; collected, analyzed, and interpreted the data; and drafted the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Herbert Chen MD.

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Disclosure

Benjamin Johnson has a financial relationship with Intuitive Surgical for proctoring and educational events, however these were not related to this current paper. Hayato Nakanishi, Shahid Miangul, Rongzhi Wang, Joe El Haddad, Nour El Ghaza, Fatma Ali Makhzoum Abdulsalam, Reem H. Matar, Christian A. Than, and Herbert Chen declare they have no competing interests.

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This systematic review and meta-analysis does not require ethical approval.

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Nakanishi, H., Miangul, S., Wang, R. et al. Open Versus Laparoscopic Surgery in the Management of Adrenocortical Carcinoma: A Systematic Review and Meta-analysis. Ann Surg Oncol 30, 994–1005 (2023). https://doi.org/10.1245/s10434-022-12711-w

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