Surgical Management of Adrenocortical Carcinoma: Current Highlights

Cavallaro, Giuseppe; Tarallo, Mariarita; Chiappini, A; Crocetti, Daniele; Polistena, Andrea; Petramala, Luigi; Sibio, Simone; Toma, Giorgio De; Fiori, Enrico; Letizia, Claudio

doi:10.3390/biomedicines9080909

Cited by 14 publications

(18 citation statements)

References 83 publications

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“…An earlier study reported lower 30-day mortality (0.5%) post-laparoscopic adrenalectomy ( 35 ). A recent systematic review ( 36 ) including 17 studies showed that although open surgery is the gold standard approach, there were no significant differences observed in the rate and time to recurrence and cancer-specific mortality between laparoscopic and open approaches (especially for tumor stage I-II). Although the robotic approach has several advantages compared to the laparoscopic, the specific indications of robotic approach in adrenal carcinoma remain unclear ( 36 ).…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review ( 36 ) including 17 studies showed that although open surgery is the gold standard approach, there were no significant differences observed in the rate and time to recurrence and cancer-specific mortality between laparoscopic and open approaches (especially for tumor stage I-II). Although the robotic approach has several advantages compared to the laparoscopic, the specific indications of robotic approach in adrenal carcinoma remain unclear ( 36 ). The perioperative safety was found to be similar in the laparoscopic and robotic approaches; however, the hospital length of stay was better in the robotic group in a meta-analysis of 21 studies ( 37 ).…”

Section: Discussionmentioning

confidence: 99%

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A Descriptive Comparative Analysis of the Surgical Management of Adrenal Tumors: The Open, Robotic, and Laparoscopic Approaches

Al-Thani

Al-Sulaiti

et al. 2022

Front. Surg.

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BackgroundCurrently, adrenalectomies are trending toward minimally invasive approach including robotic and laparoscopic surgery. We aimed to describe the clinical presentation and outcomes associated with the 3 different surgical approaches in patients who underwent adrenalectomy for adrenal mass at a single tertiary center.MethodsA retrospective descriptive observational study was conducted to include all patients who underwent surgical interventions for adrenal gland mass between 2004 and 2019. Patients were categorized into three groups according to the interventional approach (open, robotic vs. laparoscopic adrenalectomy) and data were analyzed and compared.ResultsA total of 124 patients underwent adrenalectomies (61.3% robotic, 22.6% open, and 16.1% laparoscopic approach). Incidentally discovered adrenal mass was reported in 67% of patients, and hypertension was the most prevalent comorbidity (53%). The tendency for malignancy increased with increasing tumor size while the functioning tumors were more in the smaller tumor size. Larger tumors were more common in younger patients. The robotic approach showed shorter surgical intensive care and hospital length of stay. Patients in the open adrenalectomy group frequently presented with abdominal pain (p = 0.001), had more nonfunctional adrenal mass (p = 0.04), larger mean tumor size (p = 0.001), and were frequently operated on the right side (p = 0.03). There was no post-operative mortality; however, during follow-up, 8 patients died (3 open, 3 laparoscopic and, 2 robotic approach). The median follow-up was 746 days (range 7–5,840).ConclusionsThe study explored the three surgical adrenalectomy approaches in a dedicated center for patients with adrenal pathology. It showed that robotic adrenalectomy could be safe and effective surgical approach for patients with benign functioning adrenal tumors of a diameter <6 cm. However, the choice of a surgical approach varies according to the adrenal mass presentation, patient fitness for surgery, type and sizes of the tumor, surgeon's experience, and hospital resources. Open surgery is considered the first choice for larger, ruptured adrenal tumor or malignancy. However, the recent restructuring of the surgical department resulted in selection bias in favor of the robotic surgery. Further studies are required to address the risk factors, selection criteria for appropriate management, cost, and quality of life.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Descriptive Comparative Analysis of the Surgical Management of Adrenal Tumors: The Open, Robotic, and Laparoscopic Approaches

Al-Thani

Al-Sulaiti

et al. 2022

Front. Surg.

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“…Recent systematic reviews and meta-analyses were performed on limited and heterogeneous data and led to conflicting conclusions on this debated issue [ 3 , 20 , 23 , 24 , 25 ]. The recently published guidelines on the management of ACC confirmed OA as the gold standard approach; however, they considered LA as acceptable in tumors smaller than 6 cm without any evidence of local invasion [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Adrenocortical Carcinoma: A Literature Review

Rossi

Becucci

Ambrosini

et al. 2022

JCM

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Background: Adrenocortical carcinoma (ACC) is a rare malignant tumor with a poor prognosis. Radical surgical resection with negative margins represents the only opportunity for a potential cure. This review provides a critical assessment of the existing studies regarding the surgical approaches for the treatment of ACC. Methods: This review was performed according to criteria reported in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The research was carried out using the PubMed electronic library. This review is limited to comparative studies evaluating minimally invasive adrenalectomy (MIA) and open adrenalectomy (OA) in adult patients affected by ACC. Results: A total of 14 studies were selected for the review, reporting that 2574 patients underwent adrenal surgery for ACC: 1779 (69.1%) by means of OA and 795 (30.8%) by means of MIA. Six studies considered OA to be superior to MIA, whereas eight studies reported that MIA is as effective as OA in highly selected cases. All studies were retrospective with a heterogenous selection of patients. Conclusions: Data regarding the management of MIA are scarce, heterogenous, and mainly based on retrospective studies. OA remains the gold standard approach for the management of ACC; however, MIA may play a role in selected cases treated in high volume institutions with experienced surgeons.

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“…Given that the only chance for a cure in case of an adrenocortical carcinoma is a complete primary tumor resection, with no tumor capsule rupture or spillage of tumor cells, it is recommended to perform an en bloc resection of the adremal tumor with the peritumoral/periadrenal retroperitoneal fat. Although open adrenalectomy is the standard of surgical care [ 43 ], in patients with ACC stage I-II, there are no significant differences in terms of overall recurrence rate, time to recurrence, and cancer-specific mortality between the open and laparoscopic approaches [ 45 ].…”

Section: Potentially Malignant Adrenal Massmentioning

confidence: 99%

Is the Adrenal Incidentaloma Functionally Active? An Approach-To-The-Patient-Based Review

Bernardi

Calabrò

Cavallaro

et al. 2022

JCM

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Adrenal incidentalomas are a common occurrence. Most of them are adrenocortical adenomas that do not cause harm and do not require surgery, but a non-negligible proportion of incidentalomas is represented by functionally active masses, including cortisol-secreting adenomas (12%), pheochromocytomas (3–6%), aldosterone-secreting adenomas (2–3%), as well as malignant nodules, such as adrenocortical carcinomas (2–5%), which can be either functioning or non-functioning. All patients with an adrenal incidentaloma should undergo a few biochemical screening and confirmatory tests to exclude the presence of a functionally active mass. In this approach-to-the-patient-based review, we will summarize current recommendations on biochemical evaluation and management of functionally active adrenal incidentalomas. For this purpose, we will present four case vignettes, whereby we will describe how patients were managed, then we will review and discuss additional considerations tied to the diagnostic approach, and conclude with practical aspects of patient perioperative management. To improve the perioperative management of patients with functional adrenal incidentalomas, multidisciplinary meetings are advocated.

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Surgical Management of Adrenocortical Carcinoma: Current Highlights

Cited by 14 publications

References 83 publications

A Descriptive Comparative Analysis of the Surgical Management of Adrenal Tumors: The Open, Robotic, and Laparoscopic Approaches

A Descriptive Comparative Analysis of the Surgical Management of Adrenal Tumors: The Open, Robotic, and Laparoscopic Approaches

Surgical Management of Adrenocortical Carcinoma: A Literature Review

Is the Adrenal Incidentaloma Functionally Active? An Approach-To-The-Patient-Based Review

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