Langenbeck's Archives of Surgery

, Volume 397, Issue 2, pp 201–207 | Cite as

Adrenocortical carcinoma: effect of hospital volume on patient outcome

  • Celestino Pio Lombardi
  • Marco RaffaelliEmail author
  • Marco Boniardi
  • Giorgio De Toma
  • Luigi Antonio Marzano
  • Paolo Miccoli
  • Francesco Minni
  • Mario Morino
  • Maria Rosa Pelizzo
  • Andrea Pietrabissa
  • Andrea Renda
  • Andrea Valeri
  • Carmela De Crea
  • Rocco Bellantone
Original Article



Optimal management of adrenocortical carcinoma (ACC) involves a detailed diagnostic workup, radical surgery, and appropriate adjuvant therapy. However, due to the rarity of this disease, adequate expertise is necessary to ensure optimal patient care. We evaluated if the experience of a treating center influences the outcome of ACC.


Two hundred sixty-three patients who underwent adrenalectomy for ACC were included in a multi-institutional surgical survey and divided into 2 groups: “high-volume center” (HVC) (≥10 adrenalectomies for ACC) and “low-volume center” (LVC) (<10 adrenalectomies for ACC). A comparative analysis was performed.


One hundred seventy-two patients underwent adrenalectomy at HVC and 91 at LVC. The two groups were homogeneous for age, sex, clinical presentation, and stage. The mean lesions size of ACC was higher in HVC than in LVC (104.1 ± 54.6 vs 82.8 ± 41.3 mm; P < 0.001). A significantly higher rate of lymph node dissection (P < 0.01) and of multiorgan resection (P < 0.01) was accomplished in HVC. The number of patients who underwent adjuvant therapy was significantly higher in HVC (P < 0.001). Local recurrence rate was lower in patients treated at HVC (6% vs 18.5%; P = NS). Mean time to recurrence was significantly longer in HVC than in LVC (25.2 ± 28.1 vs 10.1 ± 7.5; P < 0.01).


The expertise of dedicated centers had a positive impact on the outcome of patients with ACC, resulting in a lower recurrence rate and improved mean time to recurrence. The improved patient outcome could be related not only to the appropriateness of the surgical procedure, but also to a more adequate multidisciplinary approach.


Adrenocortical carcinoma Patient volume Oncologic outcome Adrenal tumor 



We wish to thank Antonio Ambrosi (University of Foggia), Giuseppe Cucchiara (Hospital “Fatebenefratelli”, Rome), Giorgio Giannone (Hospital “Garibaldi - Nesima”, Catania), Gianluigi Melotti (Baggiovara Hospital, Modena), Fabio Procacciante (University “La Sapienza”, Rome), Emilio Trabucchi (University of Milano, Milan), Franco Uggeri (University of Milano Bicocca, Monza) for participating in and for their contribution in updating the Italian ACC multi-institutional surgical survey.

Conflicts of interest



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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Celestino Pio Lombardi
    • 1
  • Marco Raffaelli
    • 1
    • 12
    Email author
  • Marco Boniardi
    • 2
  • Giorgio De Toma
    • 3
  • Luigi Antonio Marzano
    • 4
  • Paolo Miccoli
    • 5
  • Francesco Minni
    • 6
  • Mario Morino
    • 7
  • Maria Rosa Pelizzo
    • 8
  • Andrea Pietrabissa
    • 9
  • Andrea Renda
    • 10
  • Andrea Valeri
    • 11
  • Carmela De Crea
    • 1
  • Rocco Bellantone
    • 1
  1. 1.Division of General and Endocrine SurgeryUniversità Cattolica del Sacro CuoreRomeItaly
  2. 2.Department of General Surgery and VideolaparoscopyNiguarda Ca’ Granda HospitalMilanItaly
  3. 3.Division of General Surgery “P. Valdoni”University “La Sapienza”RomeItaly
  4. 4.Division of General and Endocrine SurgeryUniversity “Federico II”NaplesItaly
  5. 5.Department of SurgeryUniversity of PisaPisaItaly
  6. 6.Department of SurgeryUniversity “Alma Mater Studiorum”, “S. Orsola-Malpighi” HospitalBolognaItaly
  7. 7.Division of Digestive, Colorectal and Minimal Invasive SurgeryUniversity of TurinTurinItaly
  8. 8.Department of Medical and Surgical SciencesUniversity of PaduaPaduaItaly
  9. 9.Fondazione IRCCS Policlinico S. MatteoUniversity of PaviaPaviaItaly
  10. 10.Department of SurgeryUniversity “Federico II”NaplesItaly
  11. 11.Division of General, Emergency and Minimally-Invasive SurgeryAzienda Ospedaliero-Universitaria Careggi SODFlorenceItaly
  12. 12.Istituto di Semeiotica Chirurgica, U.O. Chirurgia Generale ed EndocrinaUniversità Cattolica del Sacro CuoreRomeItaly

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