Lymphadenectomy for Adrenocortical Carcinoma: Is There a Therapeutic Benefit?

• Type of Material: Article
• Authors: Jon M. Gerry, Stanford University; Thuy B. Tran, Stanford University; Lauren M. Postlewait, Emory University; Shishir Maithel, Emory University; Jason D. Prescott, Johns Hopkins University; Tracy S. Wang, Medical College of Wisconsin; Jason A. Glenn, Medical College of Wisconsin; John E. Phay, Ohio State University; Kara Keplinger, Ohio State University; Ryan C. Fields, Washington University; Linda X. Jin, 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 Southwestern Medical Center; John C. Mansour, University of Texas Southwestern Medical Center; 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 University; Edward A. Levine, Wake Forest University; Ioannis Hatzaras, New York University; Rivfka Shenoy, New York University; Timothy M. Pawlik, Johns Hopkins University; Jeffrey A. Norton, Stanford University; George A. Poultsides, Stanford University
• Language: English
• Date: 2016-09-02
• Publisher: Springer Verlag (Germany)
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 Society of Surgical Oncology.
• Final Published Version (URL): http://dx.doi.org/10.1245/s10434-016-5536-1
• Title of Journal or Parent Work: Annals of Surgical Oncology
• ISSN: 1068-9265
• Volume: 23
• Issue: Suppl 5
• Start Page: 1
• End Page: 6
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Oncology

Abstract

Background: Lymph node metastasis is an established predictor of poor outcome for adrenocortical carcinoma (ACC); however, routine lymphadenectomy during surgical resection of ACC is not widely performed and its therapeutic role remains unclear. Methods: Patients undergoing margin-negative resection for localized ACC were identified from a multi-institutional database. Patients were stratified into 2 groups based on the surgeon’s effort or not to perform a lymphadenectomy as documented in the operative note. Clinical, pathologic, and outcome data were compared between the 2 groups. Results: Of 120 patients who met inclusion criteria from 1993 to 2014, 32 (27 %) underwent lymphadenectomy. Factors associated with lymphadenectomy were tumor size (12 vs. 9.5 cm; p = .007), palpable mass at presentation (26 vs. 12 %; p = .07), suspicious lymph nodes on preoperative imaging (44 vs. 7 %; p < .001), and need for multivisceral resection (78 vs. 36 %; p <.001). Median number of lymph nodes harvested was higher in the lymphadenectomy group (5.5 vs. 0; p < .001). In-hospital mortality (0 vs. 1.3 %; p =.72) and grade 3/4 complication rates (0 vs. 12 %; p = .061) were not significantly different. Patients who underwent lymphadenectomy had improved overall survival (5-year 76 vs. 59 %; p = .041). The benefit of lymphadenectomy on overall survival persisted on multivariate analysis (HR = 0.17; p = .006) controlling for adverse preoperative and intraoperative factors associated with lymphadenectomy, such as tumor size, palpable mass, irregular tumor edges, suspicious nodes on imaging, and multivisceral resection. Conclusions: In this multicenter study of adrenocortical carcinoma patients undergoing R0 resection, the surgeon’s effort to dissect peritumoral lymph nodes was independently associated with improved overall survival.