ASO Author Reflections: Minimally Invasive Versus Open Adrenalectomy in Patients with Adrenocortical Carcinoma: A Meta-a
- PDF / 192,352 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 95 Downloads / 204 Views
ASO AUTHOR REFLECTIONS
ASO Author Reflections: Minimally Invasive Versus Open Adrenalectomy in Patients with Adrenocortical Carcinoma: A Meta-analysis Xu Hu, MD, and Xiang Li, MD Department of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, People’s Republic of China
PAST Adrenocortical carcinoma (ACC) is a rare but aggressively malignant endocrine tumor. ACC can lead to the rapid development of locoregional invasion and distant metastasis, so the prognosis of ACC patients is poor.1 Local recurrence may be associated with inadequate primary surgery, and there are few additional effective therapies for this disease. Therefore, complete resection of the tumor is the cornerstone and curative treatment modality for ACC patients.2 Open adrenalectomy (OA) with regional lymph node dissection (LND) is usually considered to be the best surgical treatment, because it can provide maximum exposure, thus reduce the possibility of tumor spillage, facilitate complete resection, and improve margin control.1,2 In addition, when necessary, it can allow for vascular control. However, open surgery is mostly associated with greater trauma, increased risk of postoperative complications, and longer recovery time. PRESENT Laparoscopic adrenalectomy (LA) has been widely performed for benign adrenal tumors. Robotic-assisted adrenalectomy has also been introduced. Minimally invasive adrenalectomy (MIA), including LA and roboticassisted adrenalectomy, is reported to be associated with less trauma, reduced pain, and decreased postoperative
Ó Society of Surgical Oncology 2020 First Received: 24 March 2020 X. Li, MD e-mail: [email protected]
complications.3 With the development of surgical techniques and the accumulation of evidence, some centers propose MIA as an alternative treatment for ACC patients. However, this remains controversial due to the oncological outcomes. For instance, a multi-institutional study of 201 patients demonstrated the surgical approach was not associated with survival and MIA could be performed for the patients with ACC B 10 cm.3 Brix et al.4 enrolled 152 patients and also found LA and OA did not differ with regard to disease-specific survival and recurrence-free survival in patients with stage I-III ACC with a tumor B 10 cm. However, Miller et al.5 included 156 ACC patients and observed OA is superior to LA regarding survival. In the present study, there was no significant difference in survival outcomes between MIA and OA, while MIA was associated with fewer postoperative complications and faster rehabilitation.6 MIA might be offered for selected ACC cases and performed by surgeons with appropriate laparoscopic expertise, ensuring improved survival for patients. However, MIA is not expressly recommended for ACC. FUTURE There has been no randomized controlled study that compares MIA and OA in ACC patients. And most published studies had a short follow-up time and a small sample size. Hence, a further prospective randomized study with a large scale is obligatory. Also, longer fol
Data Loading...
