Pirzada Faisal Masood, Kumar Rajeev
Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
Indian J Urol. 2025 Apr-Jun;41(2):91-97. doi: 10.4103/iju.iju_343_24. Epub 2025 Jan 29.
Adrenocortical cancer (ACC) is a rare malignancy with poor prognosis. Due to the widespread use of imaging, greater proportion of cases are being discovered at an early stage, and it is possible to surgically excise these tumors by minimally invasive (MIS) approaches, including pure laparoscopy and robotic assistance. However, due to the fear of capsular breach, tumor spill, and incomplete removal, open surgery (OS) is still the preferred option for managing ACC. The aim of this review is to compare the two approaches and assess where MIS can be option for the surgical management of ACC.
This review was performed as per the Preferred Reporting Items for Systematic Reviews statement. Studies comparing OS and MIS approaches for ACC were retrieved from the PubMed, Scopus, and Cochrane databases. The two approaches were compared for tumor characteristics and outcomes.
A total of 22 studies comparing MIS with OS were included in this review. Out of the total 4639 patients, 1411 underwent surgery by MIS and 3228 by OS. Patients operated by MIS had smaller tumors, lower operative time and blood loss with higher positive surgical margin rate, and higher rate of local recurrence. However, the overall survival was comparable between the two approaches.
MIS can be used in localized Stage-I ACC but only at high-volume centers. Stage II ACC may be considered for MIS if there is no evidence of local invasion and the surgery can be performed without capsular perforation and conversion to OS.
肾上腺皮质癌（ACC）是一种预后较差的罕见恶性肿瘤。由于影像学检查的广泛应用，越来越多的病例在早期被发现，并且可以通过微创（MIS）方法进行手术切除，包括单纯腹腔镜手术和机器人辅助手术。然而，由于担心包膜破裂、肿瘤播散和切除不完全，开放手术（OS）仍然是治疗ACC的首选方法。本综述的目的是比较这两种手术方法，并评估MIS在ACC手术治疗中可以作为一种选择的情况。
本综述按照系统评价的首选报告项目声明进行。从PubMed、Scopus和Cochrane数据库中检索比较ACC的OS和MIS手术方法的研究。比较这两种手术方法的肿瘤特征和手术结果。
本综述共纳入22项比较MIS与OS的研究。在总共4639例患者中，1411例接受了MIS手术，3228例接受了OS手术。接受MIS手术的患者肿瘤较小，手术时间和失血量较少，但手术切缘阳性率较高，局部复发率较高。然而，两种手术方法的总生存率相当。
MIS可用于局限性I期ACC，但仅适用于高容量中心。如果没有局部侵犯的证据，且手术可以在不发生包膜穿孔和不转为OS的情况下进行，则II期ACC可考虑采用MIS手术。
