Minimally Invasive Surgery for Resectable Adrenocortical Carcinoma: A Nationwide Analysis

Delman, Aaron M.; Turner, Kevin M.; Griffith, Azante; Schepers, Emily; Ammann, Allison M; Holm, Tammy M.

doi:10.1016/j.jss.2022.04.078

Cited by 3 publications

(5 citation statements)

References 21 publications

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“…One notable predictor of noncurative resection was treatment at a nonacademic institution. Substantiating a recent study by Delman et al, we found that MIS resection of ACC is rapidly expanding in the United States 14 . Our results further show that this increase is almost entirely attributable to nonacademic centers.…”

Section: Discussionsupporting

confidence: 89%

“…Consensus guidelines including the ACC management guidelines from 2018 European Society of Endocrinology in collaboration with the European Network for the Study of Adrenal Tumors have historically recommended that high risk adrenal nodules be removed via an OA surgical approach due to concerns for locoregional recurrence and noncurative resection with a MIS approach 5–8,13 . In recent years, adrenalectomies are increasingly being performed via MIS approach 14 . Regardless of surgical approach, there is unequivocal consensus that an appropriate oncologic surgery entails an R0 resection with an intact adrenal capsule.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8]13 In recent years, adrenalectomies are increasingly being performed via MIS approach. 14 Regardless of surgical approach, there is unequivocal consensus that an appropriate oncologic surgery entails an R0 resection with an intact adrenal capsule. It is rarely feasible to determine with confidence whether an adrenal mass is ACC in the preoperative setting.…”

Section: Consensus Guidelines Including the Acc Management Guidelines...mentioning

confidence: 99%

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Laparoscopic surgery for adrenocortical carcinoma: Estimating the risk of margin‐positive resection

Carlisle,

Blackburn,

Japp

et al. 2023

Journal of Surgical Oncology

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BackgroundOver recent years, there has been increasing adoption of minimally invasive surgery (MIS) in the treatment of adrenocortical carcinoma (ACC). However, MIS has been associated with noncurative resection and locoregional recurrence. We aimed to identify risk factors for margin‐positivity among patients who undergo MIS resection for ACC. We hypothesized that a simple nomogram can accurately identify patients most suitable for curative MIS resection.MethodsCurative‐intent resections for ACC were identified through the National Cancer Database spanning 2010–2018. Trends in MIS utilization were reported using Pearson correlation coefficients. Factors associated with margin‐positive resection were identified among preoperatively available variables using multivariable logistic regression, then incorporated into a predictive model. Model quality was cross validated using an 80% training data set and 20% test data set.ResultsAmong 1260 ACC cases, 38.6% (486) underwent MIS resection. MIS utilization increased over time at nonacademic centers (R = 0.818, p = 0.007), but not at academic centers (R = 0.009, p = 0.982). Factors associated with margin‐positive MIS resection were increasing age, nonacademic center (odds ratio [OR]: 1.8, p = 0.006), cT3 (OR: 4.7, p < 0.001) or cT4 tumors (OR: 14.6, p < 0.001), and right‐sided tumors (OR: 2.0, p = 0.006). A predictive model incorporating these four factors produced favorable c‐statistics of 0.75 in the training data set and 0.72 in the test data set. A pragmatic nomogram was created to enable bedside risk stratification.ConclusionsAn increasing proportion of ACC are resected via minimally invasive operations, particularly at nonacademic centers. Patient selection based on a few key factors can minimize the risk of noncurative surgery.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Consensus Guidelines Including the Acc Management Guidelines...mentioning

confidence: 99%

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Laparoscopic surgery for adrenocortical carcinoma: Estimating the risk of margin‐positive resection

Carlisle,

Blackburn,

Japp

et al. 2023

Journal of Surgical Oncology

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“…Delman et al. compared open vs laparoscopic surgery for ACC and reported that the overall survival was the same for both 15 . Additionally, Cavallaro et al.…”

Section: Discussionmentioning

confidence: 99%

“…14 Delman et al compared open vs laparoscopic surgery for ACC and reported that the overall survival was the same for both. 15 Additionally, Cavallaro et al recommended open surgery for tumors larger than 8 cm. 16 In the laparoscopic surgery group of the present study, 29% of patients were classified as T1, 64% as T2, 7% as T3, and no T4 cases were observed, while in the open surgery group, 6% were classified as T1, 71% as T2, 6% as T3, and 18% as T4.…”

Section: Figurementioning

confidence: 99%

Clinicopathological characteristics of adrenocortical carcinoma in the Kyushu–Okinawa area of Japan

Nakanishi,

Fukushima,

Inokuchi

et al. 2024

Int J of Urology

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ObjectiveAdrenocortical carcinoma is a rare condition, with limited comprehensive reports from Japan. This study aimed to review Japan's data on adrenocortical carcinoma by assessing information from 46 patients—with adrenocortical carcinoma across 10 Japanese university hospitals.MethodsWe conducted a retrospective multi‐institutional analysis of the clinical characteristics of adrenocortical carcinoma in Japan. We evaluated data from 46 patients across 10 university hospitals over 10 years and analyzed the relationship between clinicopathological characteristics and overall survival.ResultsFive‐ and 10‐year overall survival rates were 59% and 53%, respectively. Overall survival was significantly different among the tumor–node–metastasis system for adrenocortical carcinoma of the American Joint Committee on Cancer/International Union Against Cancer, with the worst prognosis in stage IV (p = 0.0044). In our cohort, neither the Weiss score nor the Ki‐67 proliferation index correlated with overall survival. Adjuvant treatment did not yield improved overall survival, whereas resection of the primary tumor in stage IV disease was significantly associated with improved overall survival (p = 0.0262). Out of the cases evaluated for plasma hormones, plasma cortisol, aldosterone, testosterone, and DHEA‐S levels were measured at 23%, 42%, 29%, and 62%, respectively, demonstrating higher levels than the upper normal limits.ConclusionPatients with stage IV adrenocortical carcinoma had a poor prognosis; however, resection of the primary tumor in stage IV disease was associated with prolonged survival. The results of this study are expected to contribute to future treatment of adrenocortical carcinoma in Japan.

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Defining Optimal Management of Non-metastatic Adrenocortical Carcinoma

Passman,

Amjad,

Soegaard Ballester

et al. 2023

Ann Surg Oncol

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Minimally Invasive Surgery for Resectable Adrenocortical Carcinoma: A Nationwide Analysis

Cited by 3 publications

References 21 publications

Laparoscopic surgery for adrenocortical carcinoma: Estimating the risk of margin‐positive resection

Laparoscopic surgery for adrenocortical carcinoma: Estimating the risk of margin‐positive resection

Clinicopathological characteristics of adrenocortical carcinoma in the Kyushu–Okinawa area of Japan

Defining Optimal Management of Non-metastatic Adrenocortical Carcinoma

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