Surgery for Adrenocortical Carcinoma: Do We Have Enough Evidence to Perform Robotic Approach? A Systematic Review

Surgery is the treatment of choice for adrenocortical carcinoma (stage I-III). In recent years, many authors demonstrated the safety and feasibility of minimally invasive approaches when applied to highly selected cases. The aim of the present study is to provide an overview about technical details and surgical and oncological outcomes of robotic approach compared to traditional open or laparoscopic surgery in patients with adrenocortical carcinoma. A literature search, according to the PRISMA guidelines, was performed via PubMed, Scopus, and Cochrane Library. The search thread was robotic adrenalectomy, minimally invasive surgery, and adrenocortical carcinoma. Only studies involving patients with adrenocortical carcinoma comparing robotic approach with laparoscopic and open adrenalectomy and reporting relevant clinical outcomes were included. Among all reports identified, only three studies matching the inclusion criteria were finally selected for the analysis. All of them were retrospective and demonstrated the superiority of robotic approach over laparoscopy for adrenocortical carcinoma as regards open conversion rate with no significant differences in terms of length of stay, readmissions, and 90-day mortality. A study reported significantly higher odds of positive margins for laparoscopic adrenalectomy that seems to be associated with significantly shorter overall survival. The most relevant reports strictly concerning the robotic approach to adrenocortical carcinoma revealed the safety and feasibility of robotic surgery with better outcomes in terms of open conversion rate and negative resection margins that are powerful predictors for overall survival. Multicenter case series analysis is still needed to confirm the real advantages of robotic approach in the treatment of adrenocortical carcinoma.