Metastatic Adrenocortical Carcinoma: Results of 56 Pulmonary Metastasectomies in 24 Patients

Winkel, Jan op den; Pfannschmidt, Joachim; Muley, Thomas; Grünewald, Christian; Dienemann, Hendrik; Faßnacht, Martin; Allolio, Bruno

doi:10.1016/j.athoracsur.2011.07.088

Cited by 38 publications

(23 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…15 On the contrary, results of pulmonary meta-stasectomy for ACC appear more encouraging, with a German study of 24 patients showing that complete resection of pulmonary metastases was associated with a considerable median survival of 50 months. 16 …”

Section: Discussionmentioning

confidence: 99%

Clinical Score Predicting Long-Term Survival after Repeat Resection for Recurrent Adrenocortical Carcinoma

Tran

Maithel

Pawlik

et al. 2016

Journal of the American College of Surgeons

View full text Add to dashboard Cite

BACKGROUND Adrenocortical carcinoma (ACC) is an aggressive malignancy typically resistant to chemotherapy and radiation. Surgery, even in the setting of locally recurrent or metastatic disease, remains the only potentially curative option. However, the subset of patients who will benefit from repeat resection in this setting remains ill defined. The objective of this study was to propose a prognostic clinical score that facilitates selection of patients for repeat resection of recurrent ACC. STUDY DESIGN Patients who underwent curative-intent repeat resection for recurrent ACC at 1 of 13 academic medical centers participating in the US ACC Study Group were identified. End points included morbidity, mortality, and overall survival. RESULTS Fifty-six patients underwent repeat curative-intent resection for recurrent ACC (representing 21% of 265 patients who underwent resection for primary ACC) from 1997 to 2014. Median age was 52 years. Sites of resected recurrence included locoregional only (54%), lung only (14%), liver only (12%), combined locoregional and lung (4%), combined liver and lung (4%), and other distant sites (12%). Thirty-day morbidity and mortality rates were 40% and 5.4%, respectively. Cox regression analysis revealed that the presence of multifocal recurrence, disease-free interval <12 months, and extrapulmonary distant metastases were independent predictors of poor survival. A clinical score consisting of 1-point each for the 3 variables demonstrated good discrimination in predicting survival after repeat resection (5-year: 72% for 0 points, 32% for 1 point, 0% for 2 or 3 points; p = 0.0006, area under the curve = 0.78). CONCLUSIONS Long-term survival after repeat resection for recurrent ACC is feasible when 2 of the following factors are present: solitary tumor, disease-free interval >12 months, and locoregional or pulmonary recurrence.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical Score Predicting Long-Term Survival after Repeat Resection for Recurrent Adrenocortical Carcinoma

Tran

Maithel

Pawlik

et al. 2016

Journal of the American College of Surgeons

View full text Add to dashboard Cite

show abstract

“…Local and/or metastatic recurrences usually occur within the first 2 postoperative years, with a median interval between resection and first recurrence of approximately 1 year. Only a few studies have reported the results of surgical management of recurrent ACC.…”

Section: Surgical Management Of Metastatic And/or Recurrent Accmentioning

confidence: 99%

European Society of Endocrine Surgeons (ESES) and European Network for the Study of Adrenal Tumours (ENSAT) recommendations for the surgical management of adrenocortical carcinoma

Gaujoux

Mihai

Ensat

2017

British Journal of Surgery

173

133

View full text Add to dashboard Cite

Background: Radical surgery provides the best chance of cure for adrenocortical carcinoma (ACC), but perioperative surgical care for these patients is yet to be standardized. Methods: A working group appointed jointly by ENSAT and ESES used Delphi methodology to produce evidence-based recommendations for the perioperative surgical care of patients with ACC. Papers were retrieved from electronic databases. Evidence and recommendations were classified according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system, and were discussed until consensus was reached within the group. Results: Twenty-five recommendations for the perioperative surgical care of patients with ACC were formulated. The quality of evidence is low owing to the rarity of the disease and the lack of prospective surgical trials. Multi-institutional prospective cohort studies and prospective RCTs are urgently needed and should be strongly encouraged. Conclusion: The present evidence-based recommendations provide comprehensive advice on the optimal perioperative care for patients undergoing surgery for ACC.

show abstract

“…Pulmonary metastasectomy for primary ACC, recorded in the German national registry over two decades (1989–2009), was performed in only 24 patients who had a total of 56 pulmonary metastasectomies. The 5‐year survival rate was 25 per cent, with median survival of 50 months.…”

Section: Surgery For Metastatic Diseasementioning

confidence: 99%

Diagnosis, treatment and outcome of adrenocortical cancer

Mihai

2015

British Journal of Surgery

View full text Add to dashboard Cite

Background: Adrenocortical cancer (ACC) is a rare disease with a dismal prognosis. The majority of patients are diagnosed with advanced disease and raise difficult management challenges.Methods: All references identified in PubMed, published between 2004 and 2014, using the keywords 'adrenocortical cancer' or 'adrenal surgery' or both, were uploaded into a database. The database was interrogated using keywords specific for each field studied.Results: In all, 2049 publications were identified. There is ongoing debate about the feasibility and oncological outcomes of laparoscopic adrenalectomy for small ACCs, and data derived from institutional case series have failed to provide an evidence level above expert opinion. The use of mitotane (1-(2-chlorophenyl)-1-(4-chlorophenyl)-2,2-dichloroethane) in combination with chemotherapy in the treatment of metastatic disease has been assessed in an international randomized trial (FIRM-ACT trial) involving patients with ACC. Based on this trial, mitotane plus etoposide, doxorubicin and cisplatin is now the established first-line cytotoxic therapy owing to a higher response rate and longer median progression-free survival than achieved with streptozocin-mitotane. For patients with tumours smaller than 5 cm and with no signs of lymph node or distant metastases, survival is favourable with a median exceeding 10 years. However, the overall 5-year survival rate for all patients with ACC is only 30 per cent. Conclusion:Open and potentially laparoscopic adrenalectomy for selected patients is the main treatment for non-metastatic ACC, but the overall 5-year survival rate remains low.Cutting edge articles are invited by the BJS Editorial Team, and focus on how current research and innovation will affect future clinical practice.

show abstract

Metastatic Adrenocortical Carcinoma: Results of 56 Pulmonary Metastasectomies in 24 Patients

Cited by 38 publications

References 23 publications

Clinical Score Predicting Long-Term Survival after Repeat Resection for Recurrent Adrenocortical Carcinoma

Clinical Score Predicting Long-Term Survival after Repeat Resection for Recurrent Adrenocortical Carcinoma

European Society of Endocrine Surgeons (ESES) and European Network for the Study of Adrenal Tumours (ENSAT) recommendations for the surgical management of adrenocortical carcinoma

Diagnosis, treatment and outcome of adrenocortical cancer

Contact Info

Product

Resources

About