Open versus minimally invasive surgery for suspected adrenocortical carcinoma

Buller, Dylan; Hennessey, Alex; Ristau, Benjamin T.

doi:10.21037/tau.2020.01.11

Cited by 9 publications

(5 citation statements)

References 86 publications

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“…With this approach, equal results to open surgery can be achieved. 31,32 In a recent review on the (dis)advantages of minimally invasive surgery for lesions susceptive for ACC, 33 lower intra-operative blood loss and shorter hospitalization durations were suggested for minimally invasive surgery, while open surgery was uniformly recommended as standard of care for stage III and IV ACC. In their analysis of reports, the authors nevertheless also conclude that open surgery still should be the method of choice also for localized stages in the case of suspected ACC.…”

Section: Surgical Management Of Accmentioning

confidence: 99%

Management of adrenocortical carcinoma: are we making progress?

et al. 2021

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Adrenocortical carcinoma (ACC) is a rare malignancy characterized by aggressive biology and potential endocrine activity. Surgery can offer cure for localized disease but more than half of patients relapse and primary unresectable or metastasized disease is frequent. Prognosis of metastatic ACC is still limited, with less than 15% of patients alive at 5 years. Recent advances in understanding the molecular profile of ACC underline the high complexity of this disease, which is characterized by limited drugable molecular targets as well as by a complex interplay between a yet scarcely understood microenvironment and potential endocrine activity. Particularly steroid-excess further complicates therapeutic concepts such as immunotherapy, which have markedly improved outcome in other disease entities. To date, mitotane remains the only approved drug for adjuvant and palliative care in ACC. Standard chemotherapy-based protocols with cisplatin, doxorubicin and etoposide offer only marginal improvement in long-term outcome and the number of clinical trials conducted is low due to the rarity of the disease. In the current review, we summarize principles of oncological management for ACC from localized to advanced disease and discuss novel therapeutic strategies, including targeted therapies such as tyrosine kinase inhibitors and antibodies, immunotherapy with a focus on checkpoint inhibitors, individualized treatment concepts based on molecular characterization by next generation sequencing methods, the role of theranostics and evolvement of adjuvant therapy.

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Section: Surgical Management Of Accmentioning

confidence: 99%

Management of adrenocortical carcinoma: are we making progress?

et al. 2021

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“…In relation to recurrences, surgical approach such as open abdominal surgery and minimally invasive surgery including laparoscopic and robotic surgery may have impact on recurrences (55). However, in this study, minimally invasive surgery was performed only in stages 1 and 2, and the number of cases was too small to compare the prognosis according to the surgical method.…”

Section: Discussionmentioning

confidence: 91%

“…Recently, multiple trials are ongoing to evaluate the role of immune checkpoint inhibitors, such as anti-cytotoxic-T-lymphocyte-associated-antigen 4 (anti-CTLA-4), anti-programmed death-1 (anti-PD-1), and anti-PD-ligand-1 (PD-L1) antibodies ( 48 , 51 - 54 ). In relation to recurrences, surgical approach such as open abdominal surgery and minimally invasive surgery including laparoscopic and robotic surgery may have impact on recurrences ( 55 ). However, in this study, minimally invasive surgery was performed only in stages 1 and 2, and the number of cases was too small to compare the prognosis according to the surgical method.…”

Section: Discussionmentioning

confidence: 99%

Change of treatment modality and outcomes of adrenocortical carcinoma: a retrospective review of single tertiary center experience over 24 years

Rah¹,

Cho²,

Kim³

et al. 2022

Gland Surg

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Background: Adrenocortical carcinoma, a rare malignancy, has a poor prognosis, and the treatment modalities have not been well established. This study aimed to analyze the trend of treatment modalities and outcomes of patients with adrenocortical carcinoma. Methods:We retrospectively analyzed 94 patients with adrenocortical carcinoma between January 1995 and June 2020 for distributions according to the American Joint Committee on Cancer (AJCC) 8th edition tumor-node-metastasis (TNM) staging, the yearly trend of demographic features, differences in multidisciplinary treatment, and prognostic outcomes. Multidisciplinary treatment included any combination of treatment including surgery, mitotane, chemotherapy or radiation. Results:The mean age and tumor size were 48.9 years and 11.7 cm, respectively. Fifteen patients (16.0%) underwent surgery only, and 56 (59.0%) underwent surgery with additional multidisciplinary treatments.Initial curative treatment was performed in all patients with stage 1 (n=5), 33 patients with stage 2 (n=34, 97.1%), 12 patients with stage 3 (n=19, 63.2%), and 11 patients with stage 4 (n=36, 30.6%) (P<0.0001).Two patients (40.0%) with stage 1 presented recurrence. In stages 2, 3, and 4, 57.6%, 58.3%, and 90.9% of patients who received curative treatment had recurrences, respectively. The annual trend presented statistical differences in mitotane use that have been increasing recently (P<0.0001).Conclusions: Overall distribution of adrenocortical carcinoma stage was similar throughout the years. Although the rate of mitotane use in the treatment of patients with Adrenocortical carcinoma has increased over time, recurrences were common even after multidisciplinary curative treatment in all stages.The treatment effect and prognostic outcomes presented no promising progression even with adjuvant chemotherapy and mitotane use in addition to surgical treatment. Adrenocortical carcinoma still presented an extremely poor prognosis, and further prospective studies are needed.

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“…Incidental diagnosis of adrenal neoplasms, mostly non-functioning adenomas, is frequently reported in up to 7% of patients submitted to radiological studies for other pathologies [ 18 ]. As firstly described in 1992 by M. Gagner, LA by a transperitoneal approach, avoiding large abdominal incisions, represents the most popular surgical treatment for adrenal neoplasms.…”

Section: Discussionmentioning

confidence: 99%

Impact of Current Technology in Laparoscopic Adrenalectomy: 20 Years of Experience in the Treatment of 254 Consecutive Clinical Cases

Conzo

Patrone

Flagiello

et al. 2023

JCM

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Background: Laparoscopic adrenalectomy (LA), which avoids large abdomen incisions, is considered the gold standard technique for the treatment of benign small- and medium-size adrenal masses (<6 cm) and weighing < 100 g. A trascurable mortality and morbidity rate, short hospitalization and patient rapid recovery are the main advantages compared to traditional surgery. During the past decade, a new surgical technology has been developed that expedites a “clipless” adrenalectomy. Here, the authors analyze a clinical series of 254 consecutive patients who were affected by adrenal gland neoplasms and underwent LA by the transabdominal lateral approach over the two last decades. A literature review is also presented. Methods: Preoperative, intraoperative and postoperative data from 254 patients who underwent LA between January 2003 and December 2022 were retrospectively collected and reviewed. Diagnosis was obtained on the basis of clinical examination, laboratory values and imaging techniques. Doxazosin was preoperatively administered in the case of pheochromocytoma (PCC) while spironolactone and potassium were employed to treat Conn’s disease. The same surgeon (CG) performed all the LA and utilized the same laparoscopic transabdominal lateral approach. Different dissection tools—ultrasonic, bipolar or mixed scissors—and hemostatic agents were used during this period. The following results were obtained: 254 patients were included in the study; functioning tumors were diagnosed in 155 patients, 52 patients were affected by PCCs, 55 by Conn’s disease, 48 by Cushing’s disease. Surgery mean operative time was 137.33 min (range 100–180 min) during the learning curve adrenalectomies and 98.5 min (range 70–180) in subsequent procedures. Mean blood loss was respectively 160.2 mL (range 60–280) and 96.98 mL (range 50–280) in the first 30 procedures and the subsequent ones. Only three conversions (1.18%) to open surgery occurred. No mortality or postoperative major complications were observed, while minor complications occurred in 19 patients (3.54%). In 153 out of 155 functioning neoplasms, LA was effective in the normalization of the endocrine profile. According to our experience, a learning curve consisting of 30 cases was identified. In fact, a lower operative time and a lower complication rate was reported following 30 LA. Conclusions: LA is a safe procedure, even for masses larger than 6 cm and PCCs. Undoubtedly, the development of surgical technology has made it possible reducing operative times, performing a “clipless” adrenalectomy and extending the indications in the treatment of more complex patients. A multidisciplinary team, in referral high-volume centers, is recommended in the management of adrenal pathology. A 30-procedure learning curve is necessary to improve surgical outcomes.

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Open versus minimally invasive surgery for suspected adrenocortical carcinoma

Cited by 9 publications

References 86 publications

Management of adrenocortical carcinoma: are we making progress?

Management of adrenocortical carcinoma: are we making progress?

Change of treatment modality and outcomes of adrenocortical carcinoma: a retrospective review of single tertiary center experience over 24 years

Impact of Current Technology in Laparoscopic Adrenalectomy: 20 Years of Experience in the Treatment of 254 Consecutive Clinical Cases

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