Minimally Invasive Versus Open Adrenalectomy in Patients with Adrenocortical Carcinoma: A Meta-analysis
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ORIGINAL ARTICLE – ENDOCRINE TUMORS
Minimally Invasive Versus Open Adrenalectomy in Patients with Adrenocortical Carcinoma: A Meta-analysis Xu Hu, MD1, Wei-Xiao Yang, MM1, Yan-Xiang Shao, MD1, Wei-Chao Dou, MD1, San-Chao Xiong, MM1, and Xiang Li, MD2 1
West China School of Medicine/West China Hospital, Sichuan University, Chengdu, People’s Republic of China; Department of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, People’s Republic of China 2
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
Xu Hu, Wei-Xiao Yang and Yan-Xiang Shao have contributed equally to this article. Ó Society of Surgical Oncology 2020 First Received: 26 December 2019 X. Li, MD e-mail: [email protected]
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.
Adrenocortical carcinoma (ACC) is a rare but aggressive malignancy, with an incidence of two patients per million per year, accounting for 0.2% of cancer-caused deaths.1 The prognosis of ACC is poor, with a high rate of recurrence. Reportedly, the 5-year survival rate of patients with stage I–II disease is approximately 60%,2 while for stages III and IV disease, the 5-year survival rates are 40% and 28%, respectively. In light of evidence showing that chemotherapy and radiation are not effective in m
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