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Combined Liver and Inferior Vena Cava Resection for Adrenocortical Carcinoma

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Abstract

Purpose

Adrenocortical carcinoma (ACC) is a rare malignancy, usually diagnosed at an advanced stage when it has invaded or adhered to adjacent organs. We report our experience of performing combined liver and inferior vena cava (IVC) resection for ACC.

Methods

Six patients with clinical stage III (n = 4) or IV (n = 2) ACC underwent combined resection of the liver and IVC. Two patients underwent extended right hepatectomy, and four underwent segmentectomy. In four patients, the IVC was resected segmentally: it was replaced with expanded polytetrafluoroethylene (ePTFE) in three of these patients, and not reconstructed in one. In two patients, the IVC was partially resected and closed directly.

Results

Perioperative mortality was zero, and morbidity was 33.3%, with temporary liver failure in two patients and renal failure in one patient. Recurrence was found within 8.1 months in three (50%) of the six patients. The mean recurrence-free survival period was 20.1 ± 7.7 months (95% confidence interval [CI]: 5.1–35.4), and the median survival time was 6.1 ± 9.8 months (95% CI: 00–25.3). The 5-year disease-free survival rate was 16.7%.

Conclusions

Patients with ACC involving both the liver and IVC are candidates for partial hepatectomy and segmental IVC resection. Resection affords the possibility of negative margins, acceptable perioperative morbidity and mortality, and prolonged survival in some patients.

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References

  1. JP Luton S Cerdas L Billaud G Thomas B Guilhaume X Bertagna et al. (1990) ArticleTitleClinical features of adrenocortical carcinoma, prognostic factors, and the effect of mitotane therapy N Engl J Med 322 1195–201 Occurrence Handle2325710 Occurrence Handle1:STN:280:DyaK3c3itVOltQ%3D%3D Occurrence Handle10.1056/NEJM199004263221705

    Article  PubMed  CAS  Google Scholar 

  2. AP Dackiw JE Lee RF Gagel DB Evans (2001) ArticleTitleAdrenal cortical carcinoma World J Surg 25 914–26 Occurrence Handle11572033 Occurrence Handle10.1007/s00268-001-0030-7 Occurrence Handle1:STN:280:DC%2BD3MrisVGisQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  3. A Khorram-Manesh H Ahlman S Jansson B Wangberg O Nilsson CE Jakobsson et al. (1998) ArticleTitleAdrenocortical carcinoma: surgery and mitotane for treatment and steroid profiles for follow-up World J Surg 22 605–11 Occurrence Handle9597936 Occurrence Handle10.1007/s002689900442 Occurrence Handle1:STN:280:DyaK1c3mtVahtQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  4. ML Kendrick R Lloyd L Erickson DR Farley CS Grant GB Thompson et al. (2001) ArticleTitleAdrenocortical carcinoma: surgical progress or status quo? Arch Surg 136 543–9 Occurrence Handle11343545 Occurrence Handle10.1001/archsurg.136.5.543 Occurrence Handle1:STN:280:DC%2BD3Mzht1Onsg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  5. P Icard P Goudet C Charpenay B Andreassian B Carnaille Y Chapuis et al. (2001) ArticleTitleAdrenocortical carcinomas: surgical trends and results of a 253-patient series from the French Association of Endocrine Surgeons study group World J Surg 25 891–7 Occurrence Handle11572030 Occurrence Handle10.1007/s00268-001-0047-y Occurrence Handle1:STN:280:DC%2BD3MrisVGisg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  6. Y Yamaoka K Ozawa K Kumada Y Shimahara K Tanaka K Mori et al. (1992) ArticleTitleTotal vascular exclusion for hepatic resection in cirrhotic patients. Application of venovenous bypass Arch Surg 127 276–80 Occurrence Handle1312817 Occurrence Handle1:STN:280:DyaK387pvVWqtg%3D%3D

    PubMed  CAS  Google Scholar 

  7. L Hannoun L Delriviere P Gibbs D Borie JC Vaillant E Delva (1996) ArticleTitleMajor extended hepatic resections in diseased livers using hypothermic protection: preliminary results from the first 12 patients treated with this new technique J Am Coll Surg 183 597–605 Occurrence Handle8957462 Occurrence Handle1:STN:280:DyaK2s7hs1ektg%3D%3D

    PubMed  CAS  Google Scholar 

  8. S Ohwada T Ogawa Y Kawashima T Ohya I Kobayashi N Tomizawa et al. (1999) ArticleTitleConcomitant major hepatectomy and inferior vena cava reconstruction J Am Coll Surg 188 63–71 Occurrence Handle9915245 Occurrence Handle10.1016/S1072-7515(98)00256-7 Occurrence Handle1:STN:280:DyaK1M7ht1Cmsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  9. JP Lodge BJ Ammori KR Prasad MC Bellamy (2000) ArticleTitleEx vivo and in situ resection of inferior vena cava with hepatectomy for colorectal metastases Ann Surg 231 471–9 Occurrence Handle10749606 Occurrence Handle10.1097/00000658-200004000-00004 Occurrence Handle1:STN:280:DC%2BD3c3htlaisg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  10. AW Hemming AI Reed MR Langham SuffixJr S Fujita RJ Howard (2004) ArticleTitleCombined resection of the liver and inferior vena cava for hepatic malignancy Ann Surg 239 712–9 Occurrence Handle15082976 Occurrence Handle10.1097/01.sla.0000124387.87757.eb

    Article  PubMed  Google Scholar 

  11. JE Lee DH Berger AK el-Naggar RC Hickey R Vassilopoulou-Sellin RF Gagel et al. (1995) ArticleTitleSurgical management, DNA content, and patient survival in adrenal cortical carcinoma Surgery 118 1090–8 Occurrence Handle7491528 Occurrence Handle10.1016/S0039-6060(05)80119-9 Occurrence Handle1:STN:280:DyaK28%2FovFShtQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  12. S Ohwada S Kawate K Hamada T Yamada Y Sunose H Tsutsumi et al. (2006) ArticleTitlePerioperative real-time monitoring of indocyanine green clearance by pulse spectrophotometry predicts remnant liver functional reserve in resection of hepatocellular carcinoma Br J Surg 93 339–46 Occurrence Handle16498606 Occurrence Handle10.1002/bjs.5258 Occurrence Handle1:CAS:528:DC%2BD28XjsFOls70%3D

    Article  PubMed  CAS  Google Scholar 

  13. JM Sarmiento TC Bower KJ Cherry MB Farnell DM Nagorney (2003) ArticleTitleIs combined partial hepatectomy with segmental resection of inferior vena cava justified for malignancy? Arch Surg 138 624–30 Occurrence Handle12799333 Occurrence Handle10.1001/archsurg.138.6.624

    Article  PubMed  Google Scholar 

  14. L Chiche B Dousset E Kieffer Y Chapuis (2006) ArticleTitleAdrenocortical carcinoma extending into the inferior vena cava: presentation of a 15-patient series and review of the literature Surgery 139 15–27 Occurrence Handle16364713 Occurrence Handle10.1016/j.surg.2005.05.014

    Article  PubMed  Google Scholar 

  15. M Ruel P Bedard CG Morash M Hynes GG Barber (2001) ArticleTitleResection of right atrial tumor thrombi without circulatory arrest Ann Thorac Surg 71 733–4 Occurrence Handle11235750 Occurrence Handle10.1016/S0003-4975(00)02317-1 Occurrence Handle1:STN:280:DC%2BD3M7nsVGltg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  16. R Shinghal LA Vricella RS Mitchell J Presti SuffixJr (2003) ArticleTitleCavoatrial tumor thrombus excision without circulatory arrest Urology 62 138–40 Occurrence Handle12837443 Occurrence Handle10.1016/S0090-4295(03)00258-9

    Article  PubMed  Google Scholar 

  17. C Huguet M Ferri A Gavelli (1995) ArticleTitleResection of the suprarenal inferior vena cava. The role of prosthetic replacement Arch Surg 130 793–7 Occurrence Handle7611873 Occurrence Handle1:STN:280:DyaK2Mzjs1ejtA%3D%3D

    PubMed  CAS  Google Scholar 

  18. D Liebermann-Meffert (2000) ArticleTitleThe greater omentum. Anatomy, embryology, and surgical applications Surg Clin North Am 80 275–93 Occurrence Handle10685153 Occurrence Handle10.1016/S0039-6109(05)70406-0 Occurrence Handle1:STN:280:DC%2BD3c7kvFCitg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  19. JB Shrager JC Wain CD Wright DM Donahue GJ Vlahakes AC Moncure et al. (2003) ArticleTitleOmentum is highly effective in the management of complex cardiothoracic surgical problems J Thorac Cardiovasc Surg 125 526–32 Occurrence Handle12658194 Occurrence Handle10.1067/mtc.2003.12

    Article  PubMed  Google Scholar 

  20. F Crucitti R Bellantone A Ferrante M Boscherini P Crucitti (1996) ArticleTitleThe Italian Registry for Adrenal Cortical Carcinoma: analysis of a multiinstitutional series of 129 patients. The ACC Italian Registry Study Group Surgery 119 161–70 Occurrence Handle8571201 Occurrence Handle10.1016/S0039-6060(96)80164-4 Occurrence Handle1:STN:280:DyaK287msFCltg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  21. RD Schulick MF Brennan (1999) ArticleTitleLong-term survival after complete resection and repeat resection in patients with adrenocortical carcinoma Ann Surg Oncol 6 719–26 Occurrence Handle10622498 Occurrence Handle10.1007/s10434-999-0719-7 Occurrence Handle1:STN:280:DC%2BD3c%2Fos1aisg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  22. B Allolio S Hahner D Weismann M Fassnacht (2004) ArticleTitleManagement of adrenocortical carcinoma Clin Endocrinol (Oxf) 60 273–87 Occurrence Handle10.1046/j.1365-2265.2003.01881.x

    Article  Google Scholar 

  23. GC Zografos DL Driscoll CP Karakousis RP Huben (1994) ArticleTitleAdrenal adenocarcinoma: a review of 53 cases J Surg Oncol 55 160–4 Occurrence Handle8176925 Occurrence Handle10.1002/jso.2930550306 Occurrence Handle1:STN:280:DyaK2c3jtFOksQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  24. HR Haak J Hermans CJ van de Velde EG Lentjes BM Goslings GJ Fleuren et al. (1994) ArticleTitleOptimal treatment of adrenocortical carcinoma with mitotane: results in a consecutive series of 96 patients Br J Cancer 69 947–51 Occurrence Handle8180029 Occurrence Handle1:STN:280:DyaK2c3jsFCmtg%3D%3D

    PubMed  CAS  Google Scholar 

  25. L Tauchmanova A Colao LA Marzano L Sparano L Camera A Rossi et al. (2004) ArticleTitleAndrenocortical carcinomas: twelve-year prospective experience World J Surg 28 896–903 Occurrence Handle15593464 Occurrence Handle10.1007/s00268-004-7296-5

    Article  PubMed  Google Scholar 

  26. A Berruti M Terzolo P Sperone A Pia SD Casa DJ Gross et al. (2005) ArticleTitleEtoposide, doxorubicin and cisplatin plus mitotane in the treatment of advanced adrenocortical carcinoma: a large prospective phase II trial Endocr Relat Cancer 12 657–66 Occurrence Handle16172198 Occurrence Handle10.1677/erc.1.01025 Occurrence Handle1:CAS:528:DC%2BD2MXht1SjsrrN

    Article  PubMed  CAS  Google Scholar 

  27. LM Weiss LJ Medeiros AL Vickery SuffixJr (1989) ArticleTitlePathologic features of prognostic significance in adrenocortical carcinoma Am J Surg Pathol 13 202–6 Occurrence Handle2919718 Occurrence Handle1:STN:280:DyaL1M7kvVGntg%3D%3D Occurrence Handle10.1097/00000478-198903000-00004

    Article  PubMed  CAS  Google Scholar 

  28. LE Harrison PB Gaudin MF Brennan (1999) ArticleTitlePathologic features of prognostic significance for adrenocortical carcinoma after curative resection Arch Surg 134 181–5 Occurrence Handle10025460 Occurrence Handle10.1001/archsurg.134.2.181 Occurrence Handle1:STN:280:DyaK1M7kvVehtQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  29. A Stojadinovic RA Ghossein A Hoos A Nissan D Marshall M Dudas et al. (2002) ArticleTitleAdrenocortical carcinoma: clinical, morphologic, and molecular characterization J Clin Oncol 20 941–50 Occurrence Handle11844815 Occurrence Handle10.1200/JCO.20.4.941 Occurrence Handle1:CAS:528:DC%2BD38XitFOqtbo%3D

    Article  PubMed  CAS  Google Scholar 

  30. AM Markoe W Serber B Micaily LW Brady (1991) ArticleTitleRadiation therapy for adjunctive treatment of adrenal cortical carcinoma Am J Clin Oncol 14 170–4 Occurrence Handle1709336 Occurrence Handle10.1097/00000421-199104000-00015 Occurrence Handle1:STN:280:DyaK3M3ivFSjug%3D%3D

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan

    Susumu Ohwada, Yoshifumi Tanahashi, Susumu Kawate, Kunihiro Hamada, Hirofumi Tsutsumi, Jun Horiguchi, Yukio Koibuchi & Toru Takahashi

  2. Department of Surgery, Sudo Hospital, Annaka, Gunma, Japan

    Masaru Izumi

  3. Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan

    Masanobu Yamada

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  1. Susumu Ohwada
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Ohwada, S., Izumi, M., Tanahashi, Y. et al. Combined Liver and Inferior Vena Cava Resection for Adrenocortical Carcinoma. Surg Today 37, 291–297 (2007). https://doi.org/10.1007/s00595-006-3404-5

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  • DOI: https://doi.org/10.1007/s00595-006-3404-5

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