1
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Vodanović ID, Barač Nekić A, Šambula L, Zibar Tomšić K, Dušek T, Kaštelan D. Adverse Events of Adjuvant Mitotane Treatment for Adrenocortical Carcinoma. Endocr Res 2024:1-7. [PMID: 39277812 DOI: 10.1080/07435800.2024.2402311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 08/01/2024] [Accepted: 09/04/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND Mitotane is the cornerstone of adjuvant adrenocortical cancer (ACC) treatment. However, its use is burdened with frequent adverse events. METHODS A retrospective analysis of adverse events was performed in 26 ACC patients adjuvantly treated with mitotane. RESULTS Mitotane toxicity was present in all patients (100%). Two (7.7%) patients developed 1-3 adverse events, 15 (57.7%) experienced 4-6 adverse events and 9 (34.6%) patients had more than 6 adverse events. Two (7.7%) patients discontinued mitotane due to adverse events. CONCLUSION Careful monitoring and timely management are essential for ensuring mitotane treatment adherence and maximizing its benefits.
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Affiliation(s)
| | - Anja Barač Nekić
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Lana Šambula
- Department of Nephrology, Endocrinology and Diabetology, General Hospital Tomislav Bardek, Koprivnica, Croatia
| | - Karin Zibar Tomšić
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Tina Dušek
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Darko Kaštelan
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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2
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Knewitz DK, Castillo-Larios R, Evans LA, Cornejo J, Fullerton SM, Rao SN, Chadha RN, Elli EF. Impact of Body Mass Index ≥35 kg/m 2 on Minimally Invasive Adrenalectomy. J Laparoendosc Adv Surg Tech A 2024; 34:359-364. [PMID: 38301125 DOI: 10.1089/lap.2023.0479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Introduction: Obesity is associated with numerous chronic conditions and an increased risk for surgical complications. Laparoscopic and robotic adrenalectomy have proven effective in the resection of adrenal tumors. This study analyzes the outcomes of severely obese patients (body-mass index [BMI] ≥35 kg/m2) following minimally invasive adrenalectomy. Materials and Methods: A retrospective analysis of patients who underwent minimally invasive adrenalectomy at our institution between 2010 and 2023 was conducted. Two matching analyses were performed. The first analysis compared patients with BMI greater versus lower than 35 kg/m2. The second analysis compared outcomes between robotic and laparoscopic adrenalectomy in patients with a BMI ≥35 kg/m2. Results: A total of 278 patients were included in the study. The median tumor size was 29 mm. Adrenal tumors had similar laterality, and most were hormonally active (66.2%). The most common pathological diagnosis was pheochromocytoma (25.5%). No statistical difference was found in peri- and postoperative outcomes between patients with BMI ≥35 and <35 kg/m2 who underwent minimally invasive adrenalectomy. When the surgical approach was compared in severely obese patients, robotic adrenalectomy was associated with shorter hospital length of stay with similar operative time as the laparoscopic approach. Conclusions: Minimally invasive adrenalectomy is safe and feasible in patients with BMI ≥35 kg/m2. Robotic and laparoscopic approaches are both safe and efficient for the resection of adrenal tumors in severely obese patients.
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Affiliation(s)
| | | | - Lorna A Evans
- Department of Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Jorge Cornejo
- Department of Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Shalyn M Fullerton
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sarika N Rao
- Division of Endocrinology, Department of Medicine, and Mayo Clinic, Jacksonville, Florida, USA
| | - Ryan N Chadha
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Enrique F Elli
- Department of Surgery, Mayo Clinic, Jacksonville, Florida, USA
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3
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Giordano A, Feroci F, Podda M, Botteri E, Ortenzi M, Montori G, Guerrieri M, Vettoretto N, Agresta F, Bergamini C. Minimally invasive versus open adrenalectomy for adrenocortical carcinoma: the keys surgical factors influencing the outcomes-a collective overview. Langenbecks Arch Surg 2023; 408:256. [PMID: 37386332 DOI: 10.1007/s00423-023-02997-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/21/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE Adrenocortical carcinoma (A.C.C.) is a rare tumour, often discovered at an advanced stage and associated with a poor prognosis. Surgery is the treatment of choice. We aimed to review the different surgical approaches trying to compare their outcome. METHODS This comprehensive review has been carried out according to the PRISMA statement. The literature search was performed in PubMed, Scopus, the Cochrane Library and Google Scholar. RESULTS Among all studies identified, 18 were selected for the review. A total of 14,600 patients were included in the studies, of whom 4421 were treated by mini-invasive surgery (M.I.S.). Ten studies reported 531 conversions from M.I.S. to an open approach (OA) (12%). Differences were reported for operative times as well as for postoperative complications more often in favour of OA, whereas differences for hospitalization time in favour of M.I.S. Some studies showed an R0 resection rate from 77 to 89% for A.C.C. treated by OA and 67 to 85% for tumours treated by M.I.S. The overall recurrence rate ranged from 24 to 29% for A.C.C. treated by OA and from 26 to 36% for tumours treated by M.I.S. CONCLUSIONS OA should still be considered the standard surgical management of A.C.C. Laparoscopic adrenalectomy has shown shorter hospital stays and faster recovery compared to open surgery. However, the laparoscopic approach resulted in the worst recurrence rate, time to recurrence and cancer-specific mortality in stages I-III ACC. The robotic approach had similar complications rate and hospital stays, but there are still scarce results about oncologic follow-up.
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Affiliation(s)
- Alessio Giordano
- Department of Surgery, General Surgery unit, S. Stefano Hospital, Azienda ASL Toscana Centro, Suor Niccolina Infermiera 20/22, 59100, Prato, Italy.
| | - Francesco Feroci
- Department of Surgery, General Surgery unit, S. Stefano Hospital, Azienda ASL Toscana Centro, Suor Niccolina Infermiera 20/22, 59100, Prato, Italy
| | - Mauro Podda
- Department of Surgery, General Surgery Unit, University Hospital of Cagliari, Cagliari, Italy
| | - Emanuele Botteri
- General Surgery Unit, ASST Spedali Civili Di Brescia, Montichiari, Italy
| | - Monica Ortenzi
- Department of General Surgery, Università Politecnica Delle Marche, Ancona, Italy
| | - Giulia Montori
- Department of General Surgery, Ulss2 Marca Trevigiana, Vittorio Veneto, Italy
| | - Mario Guerrieri
- Department of General Surgery, Università Politecnica Delle Marche, Ancona, Italy
| | - Nereo Vettoretto
- General Surgery Unit, ASST Spedali Civili Di Brescia, Montichiari, Italy
| | - Ferdinando Agresta
- Department of General Surgery, Ulss2 Marca Trevigiana, Vittorio Veneto, Italy
| | - Carlo Bergamini
- Department of Emergency, Emergency General Surgery Unit, AOU Careggi, Firenze, Italy
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4
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Gaillard M, Razafinimanana M, Challine A, Araujo RLC, Libé R, Sibony M, Barat M, Bertherat J, Dousset B, Fuks D, Gaujoux S. Laparoscopic or Open Adrenalectomy for Stage I-II Adrenocortical Carcinoma: A Retrospective Study. J Clin Med 2023; 12:jcm12113698. [PMID: 37297891 DOI: 10.3390/jcm12113698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Surgical resection of adrenocortical carcinoma (ACC) is the only curative treatment. Even in localized (I-II) stages, open adrenalectomy (OA) is the gold standard, though laparoscopic adrenalectomy (LA) can be proposed in selected patients. Despite the postoperative benefits of LA, its role in the surgical management of patients with ACC remains controversial regarding oncologic outcomes. The aim of this retrospective study was to compare the outcomes of patients with localized ACC submitted to LA or OA in a referral center from 1995 to 2020. Among 180 consecutive patients operated on for ACC, 49 presented with localized ACC (19 LA and 30 OA). Baseline characteristics were similar between groups, except for tumor size. Kaplan-Meier estimates of 5-year overall survival were similar in both groups (p = 0.166) but 3-year disease-free survival was in favor of OA (p = 0.020). Though LA could be proposed in highly selected patients, OA should still be considered the standard approach in patients with known or suspected localized ACC.
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Affiliation(s)
- Martin Gaillard
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Hôpital Cochin, APHP.Centre, 75014 Paris, France
| | - Meva Razafinimanana
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Hôpital Cochin, APHP.Centre, 75014 Paris, France
| | - Alexandre Challine
- Department of Digestive Surgery, Hôpital Saint-Antoine, APHP.Sorbonne Université, 75012 Paris, France
| | - Raphael L C Araujo
- Department of Surgery, Hospital Israelita Albert Einstein, Universidade Federal de Sao Paulo, Sao Paulo 05652-900, Brazil
| | - Rossella Libé
- Department of Endocrinology, Hôpital Cochin, APHP.Centre, 75014 Paris, France
| | - Mathilde Sibony
- Department of Pathology, Hôpital Cochin, APHP.Centre, 75014 Paris, France
| | - Maxime Barat
- Department of Radiology, Hôpital Cochin, APHP.Centre, 75014 Paris, France
| | - Jérôme Bertherat
- Department of Endocrinology, Hôpital Cochin, APHP.Centre, 75014 Paris, France
| | - Bertrand Dousset
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Hôpital Cochin, APHP.Centre, 75014 Paris, France
| | - David Fuks
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Hôpital Cochin, APHP.Centre, 75014 Paris, France
| | - Sebastien Gaujoux
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hôpital Pitié-Salpêtrière, APHP.Sorbonne Université, 75013 Paris, France
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5
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Nakanishi H, Miangul S, Wang R, El Haddad J, El Ghazal N, Abdulsalam FA, Matar RH, Than CA, Johnson BE, Chen H. Open Versus Laparoscopic Surgery in the Management of Adrenocortical Carcinoma: A Systematic Review and Meta-analysis. Ann Surg Oncol 2023; 30:994-1005. [PMID: 36344710 DOI: 10.1245/s10434-022-12711-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Laparoscopic surgery is considered a standard treatment for benign adrenal tumors; however, no consensus has been reached on the optimal resection technique for adrenocortical carcinomas. This study aims to evaluate the safety and efficacy of laparoscopic surgery and open surgery in the management of adrenocortical carcinoma. METHODS The Cochrane, Embase, PubMed, Scopus, and Web of Science databases were searched for articles from inception to May 2022, by two independent reviewers using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. The review was registered prospectively on the PROSPERO database (CRD42022316050). RESULTS From 183 studies screened, 11 studies met the eligibility criteria, with a total of 1617 patients with adrenocortical carcinoma undergoing either laparoscopic surgery (n = 472) or open surgery (n = 1145). Open surgery demonstrated a lower rate of positive resection margin compared with laparoscopic surgery (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.10-2.10; I2 = 0%). Additionally, open surgery had more favorable overall survival (OR 0.56, 95% CI 0.44-0.72; I2 = 0%) and recurrence-free rates (OR 0.60, 95% CI 0.42-0.85; I2 = 38%) than laparoscopic surgery at 3 years. Hospital stay was shorter for laparoscopic surgery than open surgery (mean difference - 2.49 days, 95% CI - 2.95 to - 2.04; I2 = 45%). CONCLUSIONS Open surgery should still be considered the standard operative approach; however, laparoscopic surgery could be regarded as an effective and safe operation for selected adrenocortical carcinoma cases with appropriate laparoscopic expertise. Further randomized controlled studies with tumor stage- and resection margin-dependent survival analysis are necessary to ascertain the safety and efficacy of the treatment.
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Affiliation(s)
- Hayato Nakanishi
- St George's University of London, London, UK.,University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus
| | - Shahid Miangul
- St George's University of London, London, UK.,University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus
| | - Rongzhi Wang
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joe El Haddad
- St George's University of London, London, UK.,University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus
| | - Nour El Ghazal
- St George's University of London, London, UK.,University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus
| | - Fatma A Abdulsalam
- St George's University of London, London, UK.,University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus
| | - Reem H Matar
- St George's University of London, London, UK.,University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus.,Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Christian A Than
- St George's University of London, London, UK.,University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus.,School of Biomedical Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Benjamin E Johnson
- Division of Surgery, NorthShore University Health System, Chicago, IL, USA
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
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6
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Robotic Versus Laparoscopic Adrenalectomy: The European Experience. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00338-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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7
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Ginsburg KB, Castro Bigalli AA, Schober JP, Perlman D, Handorf EA, Chen DYT, Greenberg RE, Viterbo R, Uzzo RG, Kutikov A, Smaldone MC, Correa AF. Association of tumor size and surgical approach with oncological outcomes and overall survival in patients with adrenocortical carcinoma. Urol Oncol 2022; 40:455.e19-455.e25. [PMID: 35725937 PMCID: PMC9569182 DOI: 10.1016/j.urolonc.2022.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/08/2022] [Accepted: 05/22/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To investigate the association of surgical approach with outcomes in patients with adrenocortical carcinomas smaller and larger than 6 cm in size. METHODS We reviewed the national cancer database for patients undergoing minimally invasive adrenalectomy (MIA) and open adrenalectomy (OA) from 2010 to 2017. To adjust for differences between patients undergoing MIA and OA, we performed propensity score matching within each size strata of ≤6 cm, 6.1 to 10 cm, and 10.1 to 20 cm. We fit generalized estmiating equations with a logit link function to assess for the association of surgical approach with positive surgical margins and a Cox proportional hazards model to assess for the association of surgical approach with overall survival. RESULTS We identified 364 patients that underwent MIA (182) and OA (182) in the matched cohort. We noted 21% and 18% of patients undergoing MIA and OA had a positive surgical margin, respectively. We did not identify a significant association between surgical approach and positive surgical margins in the cohort as a whole or within each of strata. Furthermore, we did not appreciate a significant association between surgical approach and overall survival in the cohort as a whole or within each size strata. CONCLUSION In the National Cancer Database, patients undergoing MIA had similar positive surgical margins and overall survival compared with OA for masses ≤6 cm, 6.1 to 10cm, and >10 cm in size. Patients undergoing MIA should be carefully selected with surgical oncologic integrity being the primary determinants of surgical approach.
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Affiliation(s)
- Kevin B Ginsburg
- Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA; Wayne State University Department of Urology, Detroit, MI.
| | - Alberto A Castro Bigalli
- Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Jared P Schober
- Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - David Perlman
- Wayne State University Department of Urology, Detroit, MI
| | - Elizabeth A Handorf
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Philadelphia, PA
| | - David Y T Chen
- Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Richard E Greenberg
- Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Rosalia Viterbo
- Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Robert G Uzzo
- Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Alexander Kutikov
- Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Marc C Smaldone
- Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Andres F Correa
- Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA
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8
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Barac Nekic A, Knezevic N, Zibar Tomsic K, Kraljevic I, Balasko A, Skoric Polovina T, Solak M, Dusek T, Kastelan D. The Effect of Surgeon Expertise on the Outcome of Patients with Adrenocortical Carcinoma. J Pers Med 2022; 12:jpm12010100. [PMID: 35055415 PMCID: PMC8780290 DOI: 10.3390/jpm12010100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/21/2021] [Accepted: 01/07/2022] [Indexed: 11/16/2022] Open
Abstract
Complete surgical removal of adrenocortical carcinoma (ACC) represents the only chance of long-term cure. In this study, we compared the long-term outcomes of ACC patients depending on whether they had adrenal surgery performed in a high-volume (HVC) or in a low-volume (LVC) center. This retrospective study included 49 patients from the Croatian ACC Registry with the European Network for the Study of Adrenal Tumors (ENSAT) stage I–III ACC, of which 35 underwent surgery in a HVC whereas 14 of them were operated in one of the LVCs. Patients operated in the LVCs had a significantly higher rate of ACC recurrence (57.1% vs. 22.9%; p = 0.02). Accordingly, RFS was significantly longer in patients operated on in HVC (p = 0.04). The difference in RFS remained significant after controlling for age, gender, tumor size, Ki-67 index, Weiss score, and type of surgery (HR 4.55; 95% CI 1.16–17.88; p = 0.03). In addition, there is a tendency towards longer DSS in patients in the HVC group compared to those in the LVC group (p = 0.05). These results point to the centralization of adrenal surgery as a key prerequisite for improving the outcomes of ACC patients.
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Affiliation(s)
- Anja Barac Nekic
- Department of Internal Medicine, General Hospital Dubrovnik, Roka Misetica 2, 20000 Dubrovnik, Croatia
- Correspondence:
| | - Nikola Knezevic
- Department of Urology, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, Salata 2, 10000 Zagreb, Croatia; (I.K.); (T.D.); (D.K.)
| | - Karin Zibar Tomsic
- Department of Endocrinology, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; (K.Z.T.); (A.B.); (T.S.P.); (M.S.)
| | - Ivana Kraljevic
- School of Medicine, University of Zagreb, Salata 2, 10000 Zagreb, Croatia; (I.K.); (T.D.); (D.K.)
- Department of Endocrinology, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; (K.Z.T.); (A.B.); (T.S.P.); (M.S.)
| | - Annemarie Balasko
- Department of Endocrinology, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; (K.Z.T.); (A.B.); (T.S.P.); (M.S.)
| | - Tanja Skoric Polovina
- Department of Endocrinology, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; (K.Z.T.); (A.B.); (T.S.P.); (M.S.)
| | - Mirsala Solak
- Department of Endocrinology, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; (K.Z.T.); (A.B.); (T.S.P.); (M.S.)
| | - Tina Dusek
- School of Medicine, University of Zagreb, Salata 2, 10000 Zagreb, Croatia; (I.K.); (T.D.); (D.K.)
- Department of Endocrinology, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; (K.Z.T.); (A.B.); (T.S.P.); (M.S.)
| | - Darko Kastelan
- School of Medicine, University of Zagreb, Salata 2, 10000 Zagreb, Croatia; (I.K.); (T.D.); (D.K.)
- Department of Endocrinology, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; (K.Z.T.); (A.B.); (T.S.P.); (M.S.)
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9
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He Z, Chen S, Lu M, Luo Y, Liu T, Xiao Y, Wang X. A combination of laparoscopic approach and ERAS pathway optimizes outcomes and cost for adrenalectomy. Updates Surg 2021; 74:519-525. [PMID: 34635985 DOI: 10.1007/s13304-021-01188-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022]
Abstract
Enhanced recovery after surgery (ERAS) pathway comprises a set of comprehensive elements which have been reported to enhance patient postoperative prognosis. In the current study, we aimed to evaluate the effectiveness of the ERAS in patients undergoing laparoscopic adrenal resection. A retrospective review was performed to compare the outcomes of patients undergoing adrenalectomy for primary aldosteronism between the pre-ERAS period and the ERAS era. Data was generated from the traditional surgical period (September 1, 2019, to December 31, 2019) and the ERAS period (September 1, 2020, to December 31, 2020), respectively. Forty-seven adrenalectomy patients were enrolled (pre-ERAS, n = 21; ERAS, n = 26) in analysis. The results revealed that both total length of hospital stay and postoperative length of stay decreased in the ERAS period compared with the pre-ERAS period (14.19 ± 4.96 vs 11.27 ± 4.37, p = 0.015; 5.43 ± 1.08 vs 3.31 ± 0.97, p < 0.001). The medical expenses decreased significantly in the ERAS group (p < 0.05). While, the surgery-related complications, including urinary retention, retroperitoneal effusion and gastrointestinal discomfort, possessed no statistical difference. The ERAS pathway was safe and feasible for adrenalectomy in patients with primary aldosteronism. The ERAS could promote patients to quickly recover from the postoperative status to a physiological state, and decrease the length of hospitalization and medical cost after surgery.
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Affiliation(s)
- Zhiwen He
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Siming Chen
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Mengxin Lu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yongwen Luo
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Tongzu Liu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yu Xiao
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China.,Human Genetic Resource Preservation Center of Hubei Province, Wuhan, China.,Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China.,Laboratory of Precision Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xinghuan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China. .,Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China. .,Medical Research Institute, Wuhan University, Wuhan, China.
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10
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Surgical Management of Adrenocortical Carcinoma: Current Highlights. Biomedicines 2021; 9:biomedicines9080909. [PMID: 34440112 PMCID: PMC8389566 DOI: 10.3390/biomedicines9080909] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Adrenocortical carcinoma (ACC) is a rare tumor, often discovered at an advanced stage and associated with poor prognosis. Treatment is guided by staging according to the European Network for the Study of Adrenal Tumors (ENSAT) classification. Surgery is the treatment of choice for ACC. The aim of this review is to provide a complete overview on surgical approaches and management of adrenocortical carcinoma. METHODS This comprehensive review has been carried out according to the PRISMA statement. The literature sources were the databases PubMed, Scopus and Cochrane Library. The search thread was: ((surgery) OR (adrenalectomy)) AND (adrenocortical carcinoma). RESULTS Among all studies identified, 17 were selected for the review. All of them were retrospective. A total of 2498 patients were included in the studies, of whom 734 were treated by mini-invasive approaches and 1764 patients were treated by open surgery. CONCLUSIONS Surgery is the treatment of choice for ACC. Open adrenalectomy (OA) is defined as the gold standard. In recent years laparoscopic adrenalectomy (LA) has gained more popularity. No significant differences were reported for overall recurrence rate, time to recurrence, and cancer-specific mortality between LA and OA, in particular for Stage I-II. Robotic adrenalectomy (RA) has several advantages compared to LA, but there is still a lack of specific documentation on RA use in ACC.
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11
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Kastelan D, Muzurovic E, Dusek T. Approach to patients with European Network for the Study of Adrenal Tumor stages I and II adrenocortical carcinomas. Curr Opin Endocrinol Diabetes Obes 2021; 28:265-270. [PMID: 33709971 DOI: 10.1097/med.0000000000000626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Adrenocortical carcinoma (ACC) is a rare tumor with variable prognosis depending mostly on the disease stage and tumor grade. The staging system proposed by the European Network for the Study of Adrenal Tumors has a reliable prognostic potential and defines ACC stages I-IV. Due to the absence of extraadrenal tissue invasion, patients with stage I-II have a lower recurrence rate and better prognosis. This article elaborates on the current understanding of the clinical approach to this group of patients. RECENT FINDINGS Concerning the treatment, complete surgical resection of the tumor provides the only chance for cure. However, even after tumor removal, the risk of recurrence remains high and the main predictors of recurrence include tumor stage, grade (measured by Ki-67 proliferative index), and the tumor resection status. Adjuvant mitotane and/or adjuvant radiotherapy should be considered in patients with high risk of recurrence taking into account potential harmful effects of such treatment. Accordingly, careful selection of patients who may benefit from adjuvant treatment is of the utmost importance both for improving disease outcome and for avoiding potential overtreatment in patients who are at low risk of disease recurrence. SUMMARY Many aspects of the management of patients with ACC stages I and II are not entirely evidence-based, and treatment decisions rely mostly on expert opinions and data from retrospective studies. Therefore, the treatment of these patients should be restricted to specialized centers with high expertise in ACC.
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Affiliation(s)
- Darko Kastelan
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb University School of Medicine, Zagreb, Croatia
| | - Emir Muzurovic
- Department of Internal Medicine, Endocrinology Section, Clinical Centre of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Tina Dusek
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb University School of Medicine, Zagreb, Croatia
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Solak M, Kraljević I, Zibar Tomšić K, Kaštelan M, Kakarigi L, Kaštelan D. Neutrophil-Lymphocyte Ratio as a Prognostic Marker in Adrenocortical Carcinoma. Endocr Res 2021; 46:74-79. [PMID: 33416409 DOI: 10.1080/07435800.2020.1870234] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE The purpose of the present study was to analyze the impact of the neutrophil-lymphocyte ratio (NLR) on the long-term outcomes of patients with adrenocortical carcinoma (ACC). METHODS This retrospective, single-institution study included 48 patients with the diagnosis of ACC. The primary outcomes of the study were differences in overall survival (OS) and disease-specific survival (DSS) with respect to the NLR level. RESULTS Patients with ENSAT stage IV had higher levels of NLR compared to those with ENSAT stage I-III (5.7 (1.6-12.5) vs 3.3 (1.3-11); p = .01). A higher NLR was also observed among patients with cortisol-secreting tumors (4.6 (1.7-12.5) vs 2.8 (1.3-10.3); p = .003) and those with Ki-67 index >10% (4.3 (1.3-12.5) vs 2.6 (1.6-11.0); p = .005). With respect to survival, the univariate analysis revealed worse ACC-related survival (p = .02) and OS (p = .004) in patients with NLR >3.9 than in those with NLR ≤3.9. In addition, patients with NLR >3.9 had a higher Weiss score (p = .046), a higher Ki-67 index (p = .006) and a higher disease stage (p = .01) compared to patients with NLR ≤3.9. No differences between the groups were observed regarding excess glucocorticoid secretion. CONCLUSION The study demonstrated that a higher NLR level in ACC patients was associated with unfavorable outcomes in terms of DSS and OS. These results indicate that NLR might be used as an additional marker in ACC risk stratification and identification of patients with the most adverse prognosis.
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Affiliation(s)
- Mirsala Solak
- Department of Endocrinology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Ivana Kraljević
- Department of Endocrinology, University Hospital Center Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Karin Zibar Tomšić
- Department of Endocrinology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Marko Kaštelan
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Luka Kakarigi
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Darko Kaštelan
- Department of Endocrinology, University Hospital Center Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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