Laparoscopic versus Open Adrenalectomy for localised/ locally advanced primary Adrenocortical Carcinoma (ENSAT I-III) in adults. Is the Margin-free (R0) resection the predominant key which designates the surgical technique? - A review of the literature

Postgraduate Thesis uoadl:1710212 1161 Read counter

Unit:
Κατεύθυνση Ελάχιστα Επεμβατική Χειρουργική, Ρομποτική Χειρουργική και Τηλεχειρουργική με εξειδίκευση στη Γενική Χειρουργική
Library of the School of Health Sciences
Deposit date:
2017-07-10
Year:
2017
Author:
Mpaili Eustratia
Supervisors info:
Δημήτριος Δημητρούλης, Επίκ. Καθηγητής Χειρουργικής (Επιβλέπων), Ιατρική Σχολή, ΕΚΠΑ
Νικόλαος Νικητέας, Καθηγητής Χειρουργικής , Ιατρική Σχολή, ΕΚΠΑ
Ιωάννης Γκρινιάτσος, Αναπλ. Καθηγητής Χειρουργικής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Laparoscopic versus Open Adrenalectomy for localised/ locally advanced primary Adrenocortical Carcinoma (ENSAT I-III) in adults. Is the Margin-free (R0) resection the predominant key which designates the surgical technique? - A review of the literature
Languages:
English
Translated title:
Laparoscopic versus Open Adrenalectomy for localised/ locally advanced primary Adrenocortical Carcinoma (ENSAT I-III) in adults. Is the Margin-free (R0) resection the predominant key which designates the surgical technique? - A review of the literature
Summary:
Background: The aim of this study was to review the current literature on the role of laparoscopic adrenalectomy in the treatment of primary adrenocortical carcinoma (ENSAT I-III) in adults. Materials and Methods: Non-randomized control trials published between January 1999 to February 2017 were identified by searching the Pubmed, EMBASE, Cochrane Library and Google Scholar databases. Primary and secondary endpoints included surgical and pathological parameters (patients age, tumor size, ENSAT stage, type of surgical approach, period of follow-up), surgical outcomes (operative time, estimated blood loss, length of hospital stay, conversion rate to laparotomy, R0 resection, surgical margin’s status) and oncological outcomes (rate of recurrence, disease free survival and overall survival rates)were analysed. Results: A total of 13 studies with a total number of 1171 patients were included in the review. Compared with open approach, laparoscopic adrenalectomy demonstrated lower tumor size, shorter operative time, lower intraoperative blood loss, shorter postoperative hospital stay and higher local recurrence rates. No significant differences were observed between groups treated with an open or laparoscopic approach for the following criteria: R0 surgical resection status, tumor overall recurrence, postoperative disease free survival and overall survival rates. Conclusion: R0 Resection Status via its undeniable impact on Recurrence Rate (RR), Disease Free Survival (DFS) and Overall Survival (OS), is the actual predominant key factor which designates the selection of the appropriate surgical technique in the treatment of primary adrenocortical carcinoma (ENSAT I-III) in adults. Although a technically demanding procedure, laparoscopic adrenalectomy appears to be secure and feasible in the management of adrenocortical cancer in the hands of an experienced surgeon (performing >10 LAs/year), held in a referral specialised centre with sufficient experience in such cases, under the auspices of a multidisciplinary team, with respect to general surgical oncological principles.. Multicentre randomized controlled trials exploring its long-term oncological outcomes are required to determine the benefits of this procedure over the open approach.

Key Words: "adrenocortical cancer", "laparoscopy" or laparoscopic", "open", "laparoscopic versus open", "adrenalectomy", "R0 resection", "margin status" and "oncological outcome".
Main subject category:
Medicine
Keywords:
Αdrenocortical cancer, Laparoscopy, Open laparoscopic versus open adrenalectomy, R0 resection, Margin status, Oncological outcome
Index:
No
Number of index pages:
0
Contains images:
Yes
Number of references:
59
Number of pages:
32
document.pdf.pdf (431 KB) Open in new window