Results of adrenal surgery. Data of a Spanish National Survey

Villar, Jesús; Moreno, Pablo; Bollo, Elisabeth; Ramirez, Carlo B.; Muñoz, Nuria Muñoz; Martínez, Cristina Fernández; Domínguez-Adame, E.; Sancho, Juan José Alegre; Pino, José M. del; Couselo, José Manuel; Carrión, Ana; Candel, Mari Fe; Caceres, N.; Octávio, José; Mateo, F. J. Nuño; Galán, Lourdes; Ramia, José Manuel; Aguiló, Javier; Herrera, Flor

doi:10.1007/s00423-010-0697-z

Cited by 35 publications

(16 citation statements)

References 17 publications

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“…This is a significant consideration given the results of a recent cohort analysis of 3,144 adrenalec- tomies performed where the surgeon volume was found to be an independent predictor of postoperative complications [17]. These results were further confirmed in a Spanish national survey where surgeons and center volume were found to be major factors in the outcome of adrenal surgery [18].…”

Section: Discussionsupporting

confidence: 75%

“…An improved survival rate was also reported for a large series of ACC patients treated at a single tertiary care referral center where patients underwent surgeries that achieved a complete resection of all gross disease [12]. Additional studies have also clearly demonstrated that increased surgeon and hospital volume are positively associated with improved patient outcomes following adrenalectomy [17,18]. As a consequence, we can argue a similar advantage in terms of oncologic outcome, including improved disease-free survival (DFS) and overall survival (OS) rates, for ACC patients who receive early specialized care at high-volume centers (HVC).…”

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confidence: 83%

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Adrenocortical carcinoma: effect of hospital volume on patient outcome

Lombardi

Raffaelli

Boniardi

et al. 2011

Langenbecks Arch Surg

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Section: Discussionsupporting

confidence: 75%

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confidence: 83%

Adrenocortical carcinoma: effect of hospital volume on patient outcome

Lombardi

Raffaelli

Boniardi

et al. 2011

Langenbecks Arch Surg

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“…2–5 Previous studies have demonstrated that increased surgical volume is an independent predictor of lower rates of postoperative complications and shorter length of stay for patients undergoing adrenalectomy in the United States and Spain. 18,19 Furthermore, greater surgical experience has been associated with improved oncologic outcomes for patients with ACC. For example, Kerkhofs et al evaluated patients with stage I to III ACC followed in the National Cancer Registry in the Netherlands.…”

Section: Discussionmentioning

confidence: 99%

Treatment Patterns and Outcomes for Patients with Adrenocortical Carcinoma Associated with Hospital Case Volume in the United States

et al. 2014

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Background Adrenocortical carcinoma (ACC) is a rare, aggressive disease with no apparent change in treatment or survival in the United States over the past two decades. Our objective was to determine whether treatment patterns or clinical outcomes vary by hospital case volume. Methods Patients with ACC were identified from the National Cancer Database (1998–2011). High-volume centers (HVCs) were defined by a case load of ≥4 cases of primary adrenal malignancy annually, which corresponded to the 90th percentile. All other facilities were considered low-volume centers (LVCs). Results A total of 2,765 ACC patients were treated across 1,046 facilities. Compared to patients treated at LVCs, patients treated at HVCs were younger (50 vs. 54 years), with larger tumors (11.2 vs. 10.5 cm), and underwent higher rates of surgery (78.8 vs. 73.4 %), radical resection (17.3 vs. 13.9 %), regional lymph node evaluation (23.2 vs. 18.8 %), and chemotherapy including mitotane (43.8 vs. 31.0 %, all p < 0.05). There were no significant differences in median length of stay (5 vs. 5 days), 30-day readmission rates (4.0 % for HVCs vs. 3.9 % for LVCs), or 30-day postoperative mortality rates (1.9 % for HVCs vs. 3.7 % for LVCs). Median overall survival was 2.0 years for HVCs and 1.9 years for LVCs, p = 0.53. After adjusting for patient and tumor characteristics, overall survival did not differ significantly between patients treated at HVCs versus LVCs [HR = 0.89 (95 % confidence interval 0.70, 1.12)]. Conclusions Treatment at HVCs was associated with more aggressive surgical resection and chemotherapy use. Prognosis remained poor despite more aggressive treatment.

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“…Specialization of surgical treatment in rare conditions has been a controversial issue for many years, but increasing evidence suggests that treatment outcome is improved by centralization of care in specialized, high-volume centers (9,10,11,12). There is supporting evidence that this is also the case for adrenal surgery (13,14).…”

Section: Introductionmentioning

confidence: 92%

Surgery for adrenocortical carcinoma in The Netherlands: analysis of the national cancer registry data

Kerkhofs¹,

Verhoeven²,

Bonjer³

et al. 2013

European Journal of Endocrinology

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Objective: Adrenocortical carcinoma (ACC) is a rare disease with an estimated incidence of one to two cases per 1 million inhabitants. The Dutch Adrenal Network (DAN) was initiated with the aim to improve patient care and to stimulate scientific research on ACC. Currently, not all patients with ACC are treated in specialized DAN hospitals. The objective of the current investigation was to determine whether there are differences in survival between patients operated on in DAN hospitals and those operated on in non-DAN hospitals. Design: The study was set up as a retrospective and population-based survival analysis. Methods: Data on all adult ACC patients diagnosed between 1999 and 2009 were obtained from The Netherlands Cancer Registry (NCR). Overall survival was calculated and a comparison was made between DAN and non-DAN hospitals. Results: The NCR contained data of 189 patients. The median survival of patients with European Network for the Study of Adrenal Tumors stages I-III disease was significantly longer for patients operated on in a DAN hospital (nZ46) than for those operated on in a non-DAN hospital (nZ37, 5-year survival 63 vs 42%). Survival remained significantly different after correction for sex, age, year of diagnosis, and stage of disease in the multivariate analysis (hazard ratio 1.96 (95% CI 1.01-3.81), PZ0.047). Conclusion: The results associate surgery in a DAN center with a survival benefit for patients with local or locally advanced ACC. We hypothesize that a multidisciplinary approach for these patients explains the observed survival benefit. These findings should be carefully considered in view of the aim for further centralization of ACC treatment.

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Results of adrenal surgery. Data of a Spanish National Survey

Abstract: In Spain, adrenalectomy is performed in hospitals of varying complexity. Laparoscopic approach is the rule, with good results in terms of morbidity and stay. High-volume centers and surgeons had best results in terms of use of minimally invasive surgery and hospital stay.

Cited by 35 publications

References 17 publications

Adrenocortical carcinoma: effect of hospital volume on patient outcome

Adrenocortical carcinoma: effect of hospital volume on patient outcome

Treatment Patterns and Outcomes for Patients with Adrenocortical Carcinoma Associated with Hospital Case Volume in the United States

Surgery for adrenocortical carcinoma in The Netherlands: analysis of the national cancer registry data

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