Role of Additional Organ Resection in Adrenocortical Carcinoma: Analysis of 167 Patients from the U.S. Adrenocortical Carcinoma Database - PubMed (original) (raw)
. 2018 Aug;25(8):2308-2315.
doi: 10.1245/s10434-018-6546-y. Epub 2018 Jun 4.
Colleen M Kiernan 1, Thuy B Tran 2, Lauren M Postlewait 3, Shishir K Maithel 3, Jason Prescott 4, Timothy Pawlik 4, Tracy S Wang 5, Jason Glenn 5, Ioannis Hatzaras 6, Rivka Shenoy 6, John Phay 7, Lawrence A Shirley 7, Ryan C Fields 8, Linda Jin 8, Sharon Weber 9, Ahmed Salem 9, Jason Sicklick 10, Shady Gad 10, Adam Yopp 11, John Mansour 11, Quan-Yang Duh 12, Natalie Seiser 12, Konstantinos Votanopoulos 13, Edward A Levine 13, George Poultsides 2, Carmen C Solórzano 14
Affiliations
- PMID: 29868977
- PMCID: PMC6061942
- DOI: 10.1245/s10434-018-6546-y
Role of Additional Organ Resection in Adrenocortical Carcinoma: Analysis of 167 Patients from the U.S. Adrenocortical Carcinoma Database
Paula Marincola Smith et al. Ann Surg Oncol. 2018 Aug.
Abstract
Background: Adrenocortical carcinoma (ACC) is a rare and aggressive cancer. This report describes factors and outcomes associated with resection of extra-adrenal organs en bloc during index adrenalectomy.
Methods: Patients who underwent ACC resection for non-metastatic disease from 1993 to 2014 at 13 participating institutions of the US-ACC Group were included in the study. Factors associated with en bloc resection were assessed by uni- and multivariate analysis. The primary end point was overall survival.
Results: In this study, 167 patients were included and categorized as adrenalectomy with en bloc resection (AdEBR) if they had extra-adrenal organs removed or adrenalectomy (Ad) if they did not. The demographics were similar between the AdEBR (n = 68, 40.7%) and Ad groups, including age, gender, race, American Society of Anesthesiology (ASA) class, and body mass index (BMI). The AdEBR group had larger tumors (13 vs. 10 cm), more open operations (97.1 vs. 63.6%), and more lymph node dissections (LNDs) (36.8 vs. 12.1%). The most common organs removed were kidney (55.9%), liver (27.9%), and spleen (23.5%). Multiple organs were removed in 38.2% (n = 26) of the patients. Margin-negative resections were similar between the two groups. In the multivariate Cox regression adjusted for T and N stages, LND, margin, size, and hormone hypersecretion, en bloc resection was not associated with improved survival (hazard ratio [HR], 1.42; p = 0.323).
Conclusion: The study findings validated current practice by showing that en bloc resection should occur at index adrenalectomy for ACC when a T4 lesion is suspected pre- or intraoperatively, or when it is necessary to avoid tumor rupture. However, in this study, when a negative margin resection was otherwise achieved, removal of extra-adrenal organs en bloc was not associated with additional survival benefit.
Figures
FIG. 1
Kaplan–Meier survival graphs for overall and disease-free survival by en bloc resection status. a Overall survival. Log-rank test for equality of survivor (p = 0.4703). bDisease-free survival. Log-rank test for equality of survivor_(p_ = 0.2991)
Comment in
- ASO Author Reflections: Additional Organ Resection in Adrenocortical Carcinoma.
Marincola Smith P, Kiernan CM, Solórzano CC. Marincola Smith P, et al. Ann Surg Oncol. 2018 Dec;25(Suppl 3):872-873. doi: 10.1245/s10434-018-6910-y. Epub 2018 Oct 15. Ann Surg Oncol. 2018. PMID: 30324471 No abstract available.
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