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Open Versus Laparoscopic Adrenalectomy for Adrenocortical Carcinoma: A Meta-analysis of Surgical and Oncological Outcomes

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

Abstract

Purpose

This study was designed to determine the role of laparoscopic adrenalectomy (LA) in the surgical management of adrenocortical carcinoma (ACC).

Methods

A systematic literature review was performed on January 2, 2015 using PubMed. Article selection proceeded according to PRISMA criteria. Studies comparing open adrenalectomy (OA) to LA for ACC and including at least 10 cases per each surgical approach were included. Odds ratio (OR) was used for all binary variables, and weight mean difference (WMD) was used for the continuous parameters. Pooled estimates were calculated with the fixed-effect model, if no significant heterogeneity was identified; alternatively, the random-effect model was used when significant heterogeneity was detected. Main demographics, surgical outcomes, and oncological outcomes were analyzed.

Results

Nine studies published between 2010 and 2014 were deemed eligible and included in the analysis, all of them being retrospective case–control studies. Overall, they included 240 LA and 557 OA cases. Tumors treated with laparoscopy were significantly smaller in size (WMD −3.41 cm; confidence interval [CI] −4.91, −1.91; p < 0.001), and a higher proportion of them (80.8 %) more at a localized (I–II) stage compared with open surgery (67.7 %) (odds ratio [OR] 2.8; CI 1.8, 4.2; p < 0.001). Hospitalization time was in favor of laparoscopy, with a WMD of −2.5 days (CI −3.3, −1.7; p < 0.001). There was no difference in the overall recurrence rate between LA and OA (relative risk [RR] 1.09; CI 0.83, 1.43; p = 0.53), whereas development of peritoneal carcinomatosis was higher for LA (RR 2.39; CI 1.41, 4.04; p = 0.001). No difference could be found for time to recurrence (WMD −8.2 months; CI −18.2, 1.7; p = 0.11), as well as for cancer specific mortality (OR 0.68; CI 0.44, 1.05; p = 0.08).

Conclusions

OA should still be considered the standard surgical management of ACC. LA can offer a shorter hospital stay and possibly a faster recovery. Therefore, this minimally invasive approach can certainly play a role in this setting, but it should be only offered in carefully selected cases to avoid jeopardizing the oncological outcome.

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Authors and Affiliations

  1. University Hospitals Urology Institute, Case Medical Center, Cleveland, OH, USA

    Riccardo Autorino MD, PhD & Jilian Nicholas DO

  2. Urology Unit, Second University of Naples, Naples, Italy

    Riccardo Autorino MD, PhD & Marco De Sio MD, PhD

  3. Department of Urology, Tor Vergata University, Rome, Italy

    Pierluigi Bove MD & Roberto Miano MD

  4. Department of Urology, University of Modena and Reggio Emilia, Modena, Italy

    Salvatore Micali MD & Giampaolo Bianchi MD

  5. Department of Urology, S. Pio da Pietrelcina Hospital, Vasto, Italy

    Luca Cindolo MD

  6. Department of Urology and Mini-Invasive Surgery, Romolo Hospital, Crotone, Italy

    Francesco Greco MD

  7. Division of Urology, Denver Health Medical Center, Denver, CO, USA

    Fernando J. Kim MD

  8. Division of Urology, “San Luigi Gonzaga” Hospital University of Turin, Orbassano, Italy

    Cristian Fiori MD & Francesco Porpiglia MD

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  1. Riccardo Autorino MD, PhD
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  2. Pierluigi Bove MD
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  3. Marco De Sio MD, PhD
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  12. Francesco Porpiglia MD
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Corresponding author

Correspondence to Riccardo Autorino MD, PhD.

Additional information

On the behalf of Italian Endourological Association (IEA) Research Office and International Translational Research in Uro-Sciences Team (ITRUST).

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Autorino, R., Bove, P., De Sio, M. et al. Open Versus Laparoscopic Adrenalectomy for Adrenocortical Carcinoma: A Meta-analysis of Surgical and Oncological Outcomes. Ann Surg Oncol 23, 1195–1202 (2016). https://doi.org/10.1245/s10434-015-4900-x

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  • DOI: https://doi.org/10.1245/s10434-015-4900-x

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