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

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, 597 Preston Research Building 2220 Pierce Ave, Nashville, TN, 37232, USA

    Paula Marincola Smith MD, Colleen M. Kiernan MD, MPH & Carmen C. Solórzano MD

  2. Stanford University School of Medicine, Stanford, CA, USA

    Thuy B. Tran MD & George Poultsides MD

  3. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Lauren M. Postlewait MD & Shishir K. Maithel MD

  4. The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jason Prescott MD, PhD & Timothy Pawlik MD, MPH, PhD

  5. Medical College of Wisconsin, Milwaukee, WI, USA

    Tracy S. Wang MD & Jason Glenn MD

  6. New York University School of Medicine, New York, NY, USA

    Ioannis Hatzaras MD & Rivka Shenoy MD

  7. Department of Surgery, The Ohio State University, Columbus, OH, USA

    John Phay MD & Lawrence A. Shirley MD, MS

  8. Barnes-Jewish Hospital and the Alvin J. Siteman Comprehensive Cancer Center, Washington University School of Medicine, St Louis, MO, USA

    Ryan C. Fields MD & Linda Jin MD

  9. Department of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Sharon Weber MD & Ahmed Salem MD

  10. Department of Surgery, University of California San Diego, San Diego, CA, USA

    Jason Sicklick MD & Shady Gad MD

  11. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Adam Yopp MD & John Mansour MD

  12. Department of Surgery, University of California San Francisco, San Francisco, CA, USA

    Quan-Yang Duh MD & Natalie Seiser MD, PhD

  13. Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Konstantinos Votanopoulos MD & Edward A. Levine MD

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  1. Paula Marincola Smith MD
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  8. Tracy S. Wang MD
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  14. Ryan C. Fields MD
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  15. Linda Jin MD
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  16. Sharon Weber MD
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  17. Ahmed Salem MD
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  18. Jason Sicklick MD
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  19. Shady Gad MD
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  20. Adam Yopp MD
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  21. John Mansour MD
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  22. Quan-Yang Duh MD
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  23. Natalie Seiser MD, PhD
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  24. Konstantinos Votanopoulos MD
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  27. Carmen C. Solórzano MD
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Correspondence to Carmen C. Solórzano MD.

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Marincola Smith, P., Kiernan, C.M., Tran, T.B. et al. Role of Additional Organ Resection in Adrenocortical Carcinoma: Analysis of 167 Patients from the U.S. Adrenocortical Carcinoma Database. Ann Surg Oncol 25, 2308–2315 (2018). https://doi.org/10.1245/s10434-018-6546-y

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  • DOI: https://doi.org/10.1245/s10434-018-6546-y

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