Incidence of Perioperative Complications Following Resection of Adrenocortical Carcinoma and Its Association with Long-Term Survival

• Type of Material: Article
• Authors: Georgios Antonios Margonis, Johns Hopkins University; Neda Amini, Johns Hopkins University; Yuhree Kim, Johns Hopkins University; Thuy B. Tran, Stanford University; Lauren M. Postlewait, Emory University; Shishir Maithel, Emory University; Tracy S. Wang, Medical College of Wisconsin; Douglas B. Evans, Medical College of Wisconsin; Ioannis Hatzaras, New York University; Rivfka Shenoy, New York University; John E. Phay, The Ohio State University; Kara Keplinger, The Ohio State University; Ryan C. Fields, Washington University; Lindsey E. Moses, Washington University; Sharon M. Weber, University of Wisconsin; Ahmed Salem, University of Wisconsin; Jason K. Sicklick, University of California San Diego; Shady Gad, University of California San Diego; Adam C. Yopp, University of Texas; John C. Mansour, University of Texas; Quan-Yang Duh, University of California San Francisco; Natalie Seiser, University of California San Francisco; Carmen C. Solorzano, Vanderbilt University; Colleen M. Kiernan, Vanderbilt University; Konstantinos I. Votanopoulos, Wake Forest School of Medicine; Edward A. Levine, Wake Forest School of Medicine; George A. Poultsides, Stanford University; Timothy M. Pawlik, Johns Hopkins University
• Language: English
• Date: 2016-03-01
• Publisher: Springer Verlag (Germany)
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 Société Internationale de Chirurgie.
• Final Published Version (URL): http://dx.doi.org/10.1007/s00268-015-3307-y
• Title of Journal or Parent Work: World Journal of Surgery
• ISSN: 0364-2313
• Volume: 40
• Issue: 3
• Start Page: 706
• End Page: 714
• Keywords: GROWTH; Life Sciences & Biomedicine; COLORECTAL-CANCER; POSTOPERATIVE COMPLICATIONS; HEPATOCELLULAR-CARCINOMA; Surgery; Science & Technology; METASTASIS; CURATIVE RESECTION; IMPACT; SURGICAL COMPLICATIONS; OUTCOMES; ESOPHAGECTOMY
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Oncology

Abstract

Background: The association of postoperative complications with long-term oncologic outcomes remains unclear. We sought to determine the incidence of complications among patients who underwent surgery for adrenocortical carcinoma (ACC) and define the relationship of morbidity with long-term survival. Methods: Patients who underwent surgery for ACC between 1993 and 2014 were identified from 13 academic institutions participating in the US ACC group study. The incidence and type of the postoperative complications, the factors associated with them as well their association with long-term survival were analyzed. Results: A total of 265 patients with median age of 52 years (IQR 44-63) were identified; at surgery, the majority of patients underwent an open abdominal procedure (n = 169, 66.8 %). A postoperative complication occurred in 99 patients for a morbidity of 37.4 %; five patients (1.9 %) died in hospital. Factors associated with morbidity included a thoraco-abdominal operative approach (reference: open abdominal; OR 2.85, 95 % CI 1.00-8.18), and a hormonally functional tumor (OR 3.56, 95 % CI 1.65-7.69) (all P < 0.05). Presence of any complication was associated with a worse long-term outcome (median survival: no complication, 58.9 months vs. any complication, 25.1 months; P = 0.009). In multivariate analysis, after adjusting for patient- and disease-related factors postoperative infectious complications independently predicted shorter overall survival (hazard ratio (HR) 5.56, 95 % CI 2.24-13.80; P < 0.001). Conclusion: Postoperative complications were independently associated with decreased long-term survival after resection for ACC. The prevention of complications may be important from an oncologic perspective.