Operative intervention for recurrent adrenocortical cancer.

Abstract

INTRODUCTION:

Adrenocortical cancer (ACC) recurs despite apparent complete resection. We examined the survival and palliative benefit of resection for recurrent ACC.

METHODS:

A review of all patients undergoing operation for ACC between 1980 and 2010 at our institution was performed in which we compared resection with nonoperative therapy.

RESULTS:

Overall, 164 patients underwent operation for ACC, 125 of whom underwent a complete resection (R0). Recurrence occurred in 93 R0 patients (median, 15 months; range, 1.5-150 months). Symptoms at recurrence were present in 71% (66/93), including pain (34%) and hormone excess (43%). There were 67 patients who underwent reoperation for recurrence. Forty-eight of 67 patients underwent R0 resection for recurrence. Operative patients had a greater overall operative versus nonoperative management or no therapy (65 months vs 6 months, P < .01). Median survival for nonoperatively managed patients (226 days) and those undergoing no therapy (179 days) was less than for debulking (1,272 days, P = .002). R0 for recurrence (P = .005) and a disease-free interval >6 months (P < .001) were associated with survival after operation, whereas original tumor size (P = .47), grade (P = .8), and stage (P = .23) were not. Pain and hormonal symptoms improved in 84% of operative patients versus 29% of nonoperatively managed patients (P = .005). Debulking had similar symptomatic improvement to R0 resection (P = .52).

CONCLUSION:

Patients with recurrent ACC can benefit from operative intervention with improvement in survival and symptoms. Patients with a disease-free interval >6 months and complete resection are likely to benefit from resection of the recurrence, but the near universal improvement in symptoms may expand the criteria for operation in recurrent ACC.

• Authors: Benzon M Dy, Kevin B Wise, Melanie L Richards, William F Young Jr, Clive S Grant, Keith C Bible, Jordan Rosedahl, William S Harmsen, David R Farley, Geoffrey B Thompson
• Journal: Surgery (Surgery) Vol. 154 Issue 6 Pg. 1292-9; discussion 1299 (Dec 2013) ISSN: 1532-7361 [Electronic] United States
• PMID: 24238048 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 Mosby, Inc. All rights reserved.

Topics

• Adrenal Cortex Neoplasms (mortality, pathology, surgery)
• Adrenalectomy
• Adrenocortical Carcinoma (mortality, pathology, surgery)
• Disease-Free Survival
• Female
• Humans
• Kaplan-Meier Estimate
• Male
• Neoplasm Recurrence, Local (mortality, pathology, surgery)
• Palliative Care
• Prognosis
• Reoperation
• Retrospective Studies
• Treatment Outcome