101 Minimally invasive surgery may be a safe and effective treatment option for patients with early-stage adrenocortical cancer, but only when performed in high-volume centres with experienced surgeons, a major review has found. The findings were published in the Indian Journal of Urology. Adrenocortical carcinoma is a rare and aggressive form of cancer, often discovered late and typically requiring extensive open surgery to remove the tumour. However, a growing number of patients are being diagnosed earlier, thanks to improved imaging techniques. This has prompted fresh interest in whether laparoscopic or robotic-assisted surgery could offer a less invasive alternative to traditional open procedures. A new systematic review of 22 studies involving 4,639 patients compared outcomes between those who underwent minimally invasive surgery and those who had conventional open surgery. Patients in the minimally invasive group experienced shorter hospital stays, reduced blood loss, and faster operations. On average, they stayed in hospital just over five days compared with more than seven days for those who had open surgery. Despite these benefits, the review found a higher rate of local cancer recurrence and positive surgical margins in the minimally invasive group. These outcomes raise concerns about whether tumour removal in these cases is as thorough as it needs to be to prevent relapse. In particular, for patients with tumours larger than 6 cm or with signs of local invasion, open surgery remains the preferred method. Interestingly, overall survival rates between the two approaches were comparable. This suggests that when properly selected and performed in the right setting, minimally invasive procedures can be oncologically safe. Nonetheless, the technique is not without risk. Around 15 percent of patients who started with a minimally invasive procedure had to be converted mid-operation to open surgery, usually due to complications or unexpected findings. The review highlighted the importance of surgeon experience and institutional volume in determining success. High-volume centres with specialists in adrenal surgery were better able to select suitable patients and achieve optimal results with minimally invasive methods. For early-stage cancers that are well-contained and show no signs of spreading, keyhole surgery could offer a less traumatic alternative. One of the key challenges in treating this type of cancer is the risk of capsule rupture or incomplete resection during surgery, which could lead to the spread of cancer cells within the abdominal cavity. Open surgery still provides a clearer field and may allow for more controlled removal of larger or more aggressive tumours. That said, the trend towards robotic-assisted surgery is growing, with increasing adoption reported in recent years. Although the findings offer hope for certain patients, experts agree that careful selection is crucial. Minimally invasive surgery should not be considered the default choice for all adrenal cancers. Instead, it may have a valuable role for well-chosen cases at specialised centres.