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Minimally Invasive Versus Open Adrenalectomy in Patients with Adrenocortical Carcinoma: A Meta-analysis

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

Abstract

Background

Open surgery remains the preferred surgical treatment of adrenocortical carcinoma (ACC), while the role of minimally invasive adrenalectomy surgery (MIS) in ACC is still controversial. The present study was conducted to compare MIS with open adrenalectomy (OA) in ACC.

Methods

The Embase, PubMed, and Cochrane Library databases were comprehensively searched. The weighted mean difference (WMD), relative risk (RR), and hazard ratio (HR) were pooled.

Results

A total of 15 studies incorporating 2207 patients were included in the present study. MIS approaches were likely to have a comparable operation time (WMD − 17.77; p = 0.150) and postoperative complications (RR 0.74; p = 0.091) compared with OA, and were significantly associated with less blood loss (WMD − 1761.96; p = 0.016) and shorter length of stay (WMD − 2.96; p < 0.001). MIS approaches were also more likely to have an earlier recurrence (WMD − 8.42; p = 0.048) and more positive surgical margin (RR 1.56; p = 0.018) and peritoneal recurrence (RR 2.63; p < 0.001), while the overall recurrence (RR 1.07; p = 0.559) and local recurrence (RR 1.33; p = 0.160) were comparable between the two groups. Furthermore, surgical approaches did not differ in overall survival (HR 0.97; p = 0.801), cancer-specific survival (HR 1.04; p = 0.869), and recurrence/disease-free survival (HR 0.96; p = 0.791).

Conclusions

In the present study, MIS approaches were likely to have a better recovery. Although MIS approaches were associated with earlier recurrence and more positive surgical margin and peritoneal recurrence, no significant differences in survival outcomes were found. OA should still be considered as the standard treatment, but MIS approaches could be offered for selected ACC cases, and performed by surgeons with appropriate laparoscopic expertise, ensuring an improved survival for patients.

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Funding

This study did not receive any financial support.

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Author notes

  1. Xu Hu, Wei-Xiao Yang and Yan-Xiang Shao have contributed equally to this article.

Authors and Affiliations

  1. West China School of Medicine/West China Hospital, Sichuan University, Chengdu, People’s Republic of China

    Xu Hu MD, Wei-Xiao Yang MM, Yan-Xiang Shao MD, Wei-Chao Dou MD & San-Chao Xiong MM

  2. Department of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, People’s Republic of China

    Xiang Li MD

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Xu Hu, Wei-Xiao Yang, Yan-Xiang Shao, Wei-Chao Dou, San-Chao Xiong and Xiang Li declare they have no conflicts of interest.

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Hu, X., Yang, WX., Shao, YX. et al. Minimally Invasive Versus Open Adrenalectomy in Patients with Adrenocortical Carcinoma: A Meta-analysis. Ann Surg Oncol 27, 3858–3869 (2020). https://doi.org/10.1245/s10434-020-08454-1

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  • DOI: https://doi.org/10.1245/s10434-020-08454-1

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