Advertisement

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

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

Keywords

Adrenocortical carcinoma Patient volume Oncologic outcome Adrenal tumor 

Notes

Acknowledgments

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

None.

References

  1. 1.
    Dackiw APB, Lee JE, Gagel RF, Evans DB (2001) Adrenal cortical carcinoma. World J Surg 25:914–926PubMedCrossRefGoogle Scholar
  2. 2.
    Stojadinovic A, Ghossein RA, Hoos A, Nissan A, Marshall D, Dudas M, Cordon-Cardo C, Jaques DP, Brennan MF (2002) Adrenocortical carcinoma: clinical, morphologic, and molecular characterization. J Clin Oncol 20:941–950PubMedCrossRefGoogle Scholar
  3. 3.
    Schteingart DE, Doherty GM, Gauger PG, Giordano TJ, Hammer GD, Korobkin M, Worden FP (2005) Management of patients with adrenal cancer: recommendations of an international consensus conference. Endocr Relat Cancer 12:667–680PubMedCrossRefGoogle Scholar
  4. 4.
    Libè R, Fratticci A, Bertherat J (2007) Adrenocortical cancer: pathophysiology and clinical management. Endocr Relat Cancer 14:13–28PubMedCrossRefGoogle Scholar
  5. 5.
    Fassnacht M, Allolio B (2009) Clinical management of adrenocortical carcinoma. Best Prac Res Clin Endocrinol Metab 2:273–289CrossRefGoogle Scholar
  6. 6.
    Crucitti F, Bellantone R, Ferrante A, Boscherini M, Crucitti P, The ACC Italian Registry Study Group (1996) The Italian Registry for Adrenal Cortical Carcinoma: analysis of a multiinstitutional series of 129 patients. Surgery 119:161–170PubMedCrossRefGoogle Scholar
  7. 7.
    Schulick RD, Brennan MF (1999) Long-term survival after complete resection and repeat resection in patients with adrenocortical carcinoma. Ann Surg Oncol 6:719–726PubMedCrossRefGoogle Scholar
  8. 8.
    Icard P, Goudet P, Charpenay C, Andreassian B, Carnaille B, Chapuis Y, Cougard P, Henry JF, Proye C (2001) Adrenocortical carcinomas: surgical trends and results of a 253-patient series from the French Association of Endocrine Surgeons Study Group. World J Surg 25:891–897PubMedCrossRefGoogle Scholar
  9. 9.
    Vassilopoulou-Sellin R, Schultz PN (2001) Adrenocortical carcinoma. Clinical outcome at the end of the 20th century. Cancer 92:1113–1121PubMedCrossRefGoogle Scholar
  10. 10.
    Abiven G, Coste J, Groussin L, Anract P, Tissier F, Legmann P, Dousset B, Bertagna X, Bertherat J (2006) Clinical and biological features in the prognosis of adrenocortical cancer: poor outcome of cortisol-secreting tumors in a series of 202 consecutive patients. J Clin Endocrinol Metab 91:2650–2655PubMedCrossRefGoogle Scholar
  11. 11.
    Bellantone R, Ferrante A, Boscherini M, Lombardi CP, Crucitti P, Crucitti F, Favia G, Borrelli D, Boffi L, Capussotti L, Carbone G, Casaccia M, Cavallaro A, Del Gaudio A, Dettori G, Di Giovanni V, Mazziotti A, Marrano D, Masenti E, Miccoli P, Mosca F, Mussa A, Petronio R, Piat G, Marzano L et al (1997) Role of reoperation in recurrence of adrenal cortical carcinoma: results from 188 cases collected in the Italian National Registry for Adrenal Cortical Carcinoma. Surgery 122:1212–1218PubMedCrossRefGoogle Scholar
  12. 12.
    Grubbs EG, Callender GG, Xing Y, Perrier ND, Evans DB, Phan AT, Lee JE (2010) Recurrence of adrenal cortical carcinoma following resection: surgery alone can achieve results equal to surgery plus mitotane. Ann Surg Oncol 17:263–270PubMedCrossRefGoogle Scholar
  13. 13.
    Fassnach M, Johanssen S, Fenske W, Weismann D, Agha A, Beusclein F, Führer D, Jurowich C, Quinkler M, Petersenn S, Sphn M, Hahner S, Allolio B (2010) Improved survival in patients with stage II adrenocortical carcinoma followed up prospectively by specialized centers. J Clin Endocrin Metab 95:4925–4932CrossRefGoogle Scholar
  14. 14.
    Bilimoria KY, Shen WT, Elaraj D, Bentrem DJ, Winchester DJ, Kebebew E, Sturgeon C (2008) Adrenocortical carcinoma in the United States: treatment utilization and prognostic factors. Cancer 113:3130–3136PubMedCrossRefGoogle Scholar
  15. 15.
    Pommier RF, Brennan MF (1992) An eleven-year experience with adrenocortical carcinoma. Surgery 112:963–970, discussion 970–971PubMedGoogle Scholar
  16. 16.
    Johanssen S, Hahner S, Saeger W, Quinkler M, Beuschlein F, Dralle H, Haaf M, Kroiss M, Jurowich C, Langer P, Oelkers W, Spahn M, Willenberg HS, Mäder U, Allolio B, Fassnacht M (2010) Deficits in the management of patients with adrenocortical carcinoma in Germany. Dtsch Arztebl Int 107(50):885–891PubMedGoogle Scholar
  17. 17.
    Park HS, Roman SA, Sosa JA (2009) Outcomes from 3144 adrenalectomies in the United States. Which matters more, surgeon volume or specialty? Arch Surg 144:1060–1067PubMedCrossRefGoogle Scholar
  18. 18.
    Villar JM, Moreno P, Ortega J, Bollo E, Ramírez CP, Muñoz N, Martínez C, Domínguez-Adame E, Sancho J, del Pino JM, Couselo JM, Carrión A, Candel M, Cáceres N, Octavio JM, Mateo F, Galán L, Ramia JM, Aguiló J, Herrera F (2010) Results of adrenal surgery. Data of a Spanish national survey. Langebecks Arch Surg 395:837–843CrossRefGoogle Scholar
  19. 19.
    Anonymous (2002) NIH state-of-the-science statement on management of the clinically unapparent adrenal mass (“incidentaloma”). NIH Consensus State Sci Statements 19(2):1–25Google Scholar
  20. 20.
    Kloos RT, Gross MD, Francis IR, Korobkin M, Shapiro B (1995) Incidentally discovered adrenal masses. Endocr Rev 16:460–484PubMedGoogle Scholar
  21. 21.
    Macfarlane DA (1958) Cancer of the adrenal cortex: the natural history, prognosis and treatment in a study of fifty-five cases. Ann R Coll Surg Engl 23:155–186PubMedGoogle Scholar
  22. 22.
    Sulivan M, Boileau M, Hodges CV (1958) Adrenal cortical carcinoma. J Urol 120:155–186Google Scholar
  23. 23.
    Miller BS, Ammori JB, Gauger PG, Broome JT, Hammer GD, Doherty GM (2010) Laparoscopic resection is inappropriate in patients with known or suspected adrenocortical carcinoma. World J Surg 34:1380–1385PubMedCrossRefGoogle Scholar
  24. 24.
    Porpiglia F, Fiori C, Daffara F, Zaggia B, Bollito E, Volante M, Berutti A, Terzolo M (2010) Retrospective evaluation of the outcome of open versus laparoscopic adrenalectomy for stage I and II adrenocortical cancer. Eur Urol 57:873–878PubMedCrossRefGoogle Scholar
  25. 25.
    Brix D, Allolio B, Fenske W, Agha A, Dralle H, Jurowich C, Langer P, Mussack T, Nies C, Riedmiller H, Spahn M, Weismann D, Hahner S, Fassnacht M, German Adrenocortical Carcinoma Registry Group (2010) Laparoscopic versus open adrenalectomy for adrenocortical carcinoma: surgical and oncologic outcome in 152 patients. Eur Urol 58:609–615PubMedCrossRefGoogle Scholar
  26. 26.
    Terzolo M, Angeli A, Fassnacht M, Daffara F, Tauchmanova L, Conton PA, Rossetto R, Buci L, Sperone P, Grossrubatscher E, Reimondo G, Bollito E, Papotti M, Saeger W, Hahner S, Koschker AC, Arvat E, Ambrosi B, Loli P, Lombardi P, Mannelli M, Bruzzi P, Mantero F, Allolio B, Dogliotti L, Berruti A (2007) Adjuvant mitotane treatment in patients with adrenocortical carcinoma. N Engl J Med 356:372–380CrossRefGoogle Scholar

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

Personalised recommendations