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01-08-2018 | Endocrine Tumors

Role of Additional Organ Resection in Adrenocortical Carcinoma: Analysis of 167 Patients from the U.S. Adrenocortical Carcinoma Database

Authors: Paula Marincola Smith, MD, Colleen M. Kiernan, MD, MPH, Thuy B. Tran, MD, Lauren M. Postlewait, MD, Shishir K. Maithel, MD, Jason Prescott, MD, PhD, Timothy Pawlik, MD, MPH, PhD, Tracy S. Wang, MD, Jason Glenn, MD, Ioannis Hatzaras, MD, Rivka Shenoy, MD, John Phay, MD, Lawrence A. Shirley, MD, MS, Ryan C. Fields, MD, Linda Jin, MD, Sharon Weber, MD, Ahmed Salem, MD, Jason Sicklick, MD, Shady Gad, MD, Adam Yopp, MD, John Mansour, MD, Quan-Yang Duh, MD, Natalie Seiser, MD, PhD, Konstantinos Votanopoulos, MD, Edward A. Levine, MD, George Poultsides, MD, Carmen C. Solórzano, MD

Published in: Annals of Surgical Oncology | Issue 8/2018

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.

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Title: Role of Additional Organ Resection in Adrenocortical Carcinoma: Analysis of 167 Patients from the U.S. Adrenocortical Carcinoma Database
Authors: Paula Marincola Smith, MD
Colleen M. Kiernan, MD, MPH
Thuy B. Tran, MD
Lauren M. Postlewait, MD
Shishir K. Maithel, MD
Jason Prescott, MD, PhD
Timothy Pawlik, MD, MPH, PhD
Tracy S. Wang, MD
Jason Glenn, MD
Ioannis Hatzaras, MD
Rivka Shenoy, MD
John Phay, MD
Lawrence A. Shirley, MD, MS
Ryan C. Fields, MD
Linda Jin, MD
Sharon Weber, MD
Ahmed Salem, MD
Jason Sicklick, MD
Shady Gad, MD
Adam Yopp, MD
John Mansour, MD
Quan-Yang Duh, MD
Natalie Seiser, MD, PhD
Konstantinos Votanopoulos, MD
Edward A. Levine, MD
George Poultsides, MD
Carmen C. Solórzano, MD
Publication date: 01-08-2018
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 8/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-018-6546-y

At a glance: The STEP trials

Springer Medicine

Role of Additional Organ Resection in Adrenocortical Carcinoma: Analysis of 167 Patients from the U.S. Adrenocortical Carcinoma Database

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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