Operative management for recurrent and metastatic adrenocortical carcinoma.


OBJECTIVE A review of all resections for recurrent or metastatic ACC was performed to identify patients who might benefit from a surgical approach, and to identify factors that might aid in prognosis among patients with metastatic disease. SUMMARY BACKGROUND DATA Adrenocortical carcinoma (ACC) is a rare tumor, with frequent recurrences and metastases even after complete resection. Chemotherapy has limited efficacy, and surgical resection of metastatic ACC remains controversial. METHODS A retrospective review was performed of all patients who underwent surgical intervention for metastatic ACC in a single tertiary center from 1977 to 2009. All available clinicopathologic data were analyzed to determine potential factors associated with response to treatment and survival. RESULTS Fifty-seven patients underwent 116 procedures for recurrent or metastatic disease. Twenty-three resections were for liver metastases, 48 for pulmonary metastases, 22 for abdominal disease including local recurrences, and 13 were for metastases at other sites. Median and 5-year survivals from time of first metastasectomy were 2.5 years, and 41%, respectively. The median survival of patients with DFI <12 months was 1.7 years, compared to 6.6 years for patients with DFI >12 months (P = 0.015). Median survival for right versus left-sided primaries was 1.9 years versus 3.8 years (P = 0.03). Liver metastases were more common with right-sided primaries (67% vs. 41%, P = 0.05). Chemotherapy had no impact on survival. CONCLUSIONS Resection of recurrent or metastatic ACC is safe, and may result in prolongation of survival in selected patients with DFI greater than 1 year.

DOI: 10.1002/jso.23015
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@article{Datrice2012OperativeMF, title={Operative management for recurrent and metastatic adrenocortical carcinoma.}, author={Nicole M Datrice and Russell C. Langan and Robert T. Ripley and C. David Kemp and Seth Steinberg and Bradford J. Wood and Steven K. Libutti and Tito Fojo and David S. Schrump and Itzhak Avital}, journal={Journal of surgical oncology}, year={2012}, volume={105 7}, pages={709-13} }