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01-12-2023 | Adrenocortical Carcinoma | Review

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

Authors: Alessio Giordano, Francesco Feroci, Mauro Podda, Emanuele Botteri, Monica Ortenzi, Giulia Montori, Mario Guerrieri, Nereo Vettoretto, Ferdinando Agresta, Carlo Bergamini

Published in: Langenbeck's Archives of Surgery | Issue 1/2023

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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Title: Minimally invasive versus open adrenalectomy for adrenocortical carcinoma: the keys surgical factors influencing the outcomes—a collective overview
Authors: Alessio Giordano
Francesco Feroci
Mauro Podda
Emanuele Botteri
Monica Ortenzi
Giulia Montori
Mario Guerrieri
Nereo Vettoretto
Ferdinando Agresta
Carlo Bergamini
Publication date: 01-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Adrenocortical Carcinoma
Adrenalectomy
Adrenalectomy
Minimally Invasive Surgery
Published in: Langenbeck's Archives of Surgery / Issue 1/2023
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-023-02997-z

At a glance: The STEP trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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