Service de Chirurgie Endocrinienne, Université Lille Nord de France, CHU, 59037, Lille, Cedex, France.
Langenbecks Arch Surg. 2012 Feb;397(2):195-9. doi: 10.1007/s00423-011-0852-1. Epub 2011 Sep 27.
There are no randomised studies comparing open and laparoscopic approaches foradrenalectomy in patients with adrenal cortical carcinoma.
There is evidence of postoperative benefit for the patients undergoing laparoscopic adrenalectomy compared to open adrenalectomy (level B).
Results from comparison of oncological outcomes in ACC between open and laparoscopic approaches are equivocal: increasedrisk of local recurrence and peritoneal carcinomatosis by the laparoscopic route (level D), and identical results between the two approaches in terms of survival, recurrence and peritoneal carcinomatosis (level C).
An open approach is recommended in case of local invasion, with a view to achieving an R0 resection (level D). Laparoscopic resection of ACC/potentially malignant tumours, which includes removal of surrounding periadrenal fat and results in an R0 resection without tumour capsule rupture, may be performed for preoperative and intraoperative stage 1-2 ACC and tumours with a diameter < 10 cm (level C).
目前尚无随机研究比较肾上腺皮质癌患者的开放手术和腹腔镜手术方法。
与开放肾上腺切除术相比，腹腔镜肾上腺切除术对患者具有术后获益（证据级别 B）。
开放和腹腔镜方法治疗 ACC 的肿瘤学结果比较结果存在争议：腹腔镜途径有局部复发和腹膜癌病的风险增加（证据级别 D），而两种方法在生存、复发和腹膜癌病方面的结果相同（证据级别 C）。
如果存在局部侵犯，建议采用开放方法，以达到 R0 切除（证据级别 D）。对于术前和术中分期为 1-2 期的 ACC 和直径<10cm 的肿瘤，腹腔镜切除 ACC/潜在恶性肿瘤可能是可行的，包括切除周围肾上腺脂肪组织，并且不会导致肿瘤包膜破裂而达到 R0 切除（证据级别 C）。
