Laparoscopic Adrenalectomy for Large Adrenocortical Carcinoma

Abstract

Background:Adrenocortical cancer (ACC) is a rare disease that is difficult to treat. Laparoscopic adrenalectomy (LA) is performed, even for large adrenocortical carcinomas. However, the oncological effectiveness of LA remains unclear. This review presents the current knowledge of the feasibility and oncological effectiveness of laparoscopic surgery for ACC, with an analysis of data for outcomes and other parameters.Database:A systematic review of the literature was performed by searching the PubMed and Medline databases for all relevant articles in English, published between January 1992 and August 2014 on LA for adrenocortical carcinoma.Discussion:The search resulted in retrieval of 29 studies, of which 10 addressed the outcome of LA versus open adrenalectomy (OA) and included 844 patients eligible for this review. Among these, 206 patients had undergone LA approaches, and 638 patients had undergone OA. Among the 10 studies that compared the outcomes obtained with LA and OA for ACC, 5 noted no statistically significant difference between the 2 groups in the oncological outcomes of recurrence and disease-free survival, whereas the remaining 5 reported inferior outcomes in the LA group. Using a paired t test for statistical analysis, except for tumor size, we found no significant difference in local recurrence, peritoneal carcinomatosis, positive resection margin, and time to recurrence between the LA and OA groups. The overall mean tumor size in patients undergoing LA and OA was 7.1 and 11.2 cm, respectively (P = .0003), and the mean overall recurrence was 61.5 and 57.9%, respectively. The outcome of LA is believed to depend to a large extent on the size and stage of the lesion (I and II being favorable) and the surgical expertise in the center where the patient undergoes the operation. However, the present review shows no difference in the outcome between the 2 approaches across all stages. A poor outcome is likely to result from inadequate surgery, irrespective of whether the approach is open or laparoscopic.

Laparoscopic Transperitoneal Lateral Adrenalectomy for Large Adrenal Tumors

“…A systematic review by Machado et al [34] shows no difference in the outcome between the 2 approaches (open or laparoscopic) across all stages and concludes that a poor outcome is likely to result from inadequate surgery, irrespective of whether the approach is open or laparoscopic. In the statement of the European Society of Endocrine Surgeons (ESES) [35], we could find that laparoscopic resection of ACC/potentially malignant tumors may be performed for pre- and intra-operative stages 1-2 ACC and tumors with a diameter <10 cm.…”

Óriás mellékvesetumorok eltávolítása laparoszkópos transperitonealis technikával három sikeres eset kapcsán

“…A legfrissebb systematic review alapján, amely több mint 1000 beteg műtéti eredményeit hasonlította össze, megállapítható, hogy a laparoszkópos technika nem növeli az onkológiai kockázatot (helyi kiújulás, peritonealis szórás, recidívák megjelenésének ideje, tumortoksérülés), I/II. stádiumú tumorok esetén a nyitott technikával összehasonlítva [29]. Ezenkívül van néhány fontos megállapítás, amelyeket mindenféleképpen figyelembe kell venni a minimálisan invazív technika alkalmazásánál: 1.…”

Current Approaches in the Minimally Invasive Surgical Treatment of Adrenal Tumors

“…In the opinion of the authors, well-defined local invasiveness is essential for determining the suitability for laparoscopic adrenalectomy [12][13][14][15][16][17][18]. Recent data from the literature confirm that laparoscopic adrenalectomy can replicate open surgical oncologic resection of ACC, showing comparable survival and recurrence rates.…”

“…If solitary metastatic lesions are limited within the capsule of the adrenal gland, adrenalectomy can be performed [22]. Laparoscopic adrenalectomy can also be performed for high-risk lesions for malignancy, but general experience is limited, and oncologic effectiveness of minimally invasive approaches remains uncertain in this setting [12,17,18,[23][24][25][26][27][28].…”

“…Recent data from the literature confirm that laparoscopic adrenalectomy is safe and effective for malignant adrenal tumors. In some studies, outcome results with regard to peritoneal carcinomatosis, positive resection margins, and time to recurrence showed no statistically significant differences between open and laparoscopic approaches [12,[28][29][30][31][32][33]. In other studies with regard to ACC, oncologic outcomes of laparoscopic adrenalectomy were not comparable to open adrenalectomy [17,34,35].…”