Role of Additional Organ Resection in Adrenocortical Carcinoma: Analysis of 167 Patients from the US Adrenocortical Carcinoma Database

• Type of Material: Conference Paper
• Authors: Paula Marincola Smith, Vanderbilt University; Colleen M. Kiernan, Vanderbilt University; Thuy B. Tran, Stanford University; Lauren M. Postlewait, Emory University; Shishir Kumar Maithel, Emory University; Jason Prescott, Johns Hopkins University; Timothy Pawlik, Johns Hopkins University; Tracy S. Wang, Medical College of Wisconsin; Jason Glenn, Medical College of Wisconsin; Ioannis Hatzaras, New York University; Rivka Shenoy, New York University; John Phay, Ohio State University; Lawrence A. Shirley, Ohio State University; Ryan C. Fields, Washington University; Linda Jin, Washington University; Sharon Weber, University of Wisconsin; Ahmed Salem, University of Wisconsin; Jason Sicklick, University of California San Diego; Shady Gad, University of California San Diego; Adam Yopp, University of Texas Southwestern Medical Center; John Mansour, University of Texas Southwestern Medical Center; Quan-Yang Duh, University of California San Francisco; Natalie Seiser, University of California San Francisco; Konstantinos Votanopoulos, Wake Forest School of Medicine; Edward A. Levine, Wake Forest School of Medicine; George Poultsides, Stanford University; Carmen C. Solorzano, Vanderbilt University
• Language: English
• Date: 2018-08-01
• Publisher: Emory University Libraries
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018, Society of Surgical Oncology.
• Final Published Version (URL): http://dx.doi.org/10.1245/s10434-018-6546-y
• Title of Journal or Parent Work: ANNALS OF SURGICAL ONCOLOGY
• Conference or Event Name: 71st Annual Cancer Symposium of the Society-of-Surgical-Oncology
• Volume: 25
• Issue: 8
• Start Page: 2308
• End Page: 2315
• Keywords: LYMPHADENECTOMY; RECURRENCE; Surgery; SERIES; IMPACT; CANCER; INFERIOR VENA-CAVA; Oncology; Life Sciences & Biomedicine; OUTCOMES; LAPAROSCOPIC ADRENALECTOMY; IMPROVED SURVIVAL; Science & Technology; PROGNOSTIC-FACTORS
• Research Categories: Health Sciences, Oncology; Health Sciences, Medicine and Surgery

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.