Article: article from journal or magazin.
Adrenocortical carcinoma: is the surgical approach a risk factor of peritoneal carcinomatosis?
Eur J Endocrinol
1479-683X (Electronic)0804-4643 (Linking)
Leboulleux, SDeandreis, DAl Ghuzlan, AAuperin, AGoere, DDromain, CElias, DCaillou, BTravagli, J PDe Baere, TLumbroso, JYoung, JSchlumberger, MBaudin, EengEngland2010/03/30 06:00Eur J Endocrinol. 2010 Jun;162(6):1147-53. doi: 10.1530/EJE-09-1096. Epub 2010 Mar 26.
CONTEXT: Peritoneal carcinomatosis (PC) is a rare site of distant metastases in patients with adrenocortical cancer (ACC). One preliminary study suggests an increased risk of PC after laparoscopic adrenalectomy (LA) for ACC. OBJECTIVE: The objective of the study was to search for risk factors of PC including surgical approach. DESIGN: This was a retrospective cohort study conducted in an institutional practice. PATIENTS: Sixty-four consecutive patients with ACC seen at our institution between 2003 and 2009 were included. Mean tumor size was 132 mm. Patients had stage I disease in 2 cases, stage II disease in 32 cases, stage III disease in 7 cases, stage IV disease in 21 cases, and unknown stage disease in 2 cases. Surgery was open in 58 cases and laparoscopic in 6 cases. MAIN OUTCOME: The main outcome was the risk factors of PC. RESULTS: PC occurred in 18 (28%) patients. It was present at initial diagnosis in three cases and occurred during follow-up in 15 cases. The only risk factor of PC occurring during follow-up was the surgical approach with a 4-year rate of PC of 67% (95% confidence interval (CI), 30-90%) for LA and 27% (95% CI, 15-44%) for open adrenalectomy (P=0.016). Neither tumor size, stage, functional status, completeness of surgery, nor plasma level of op'DDD was associated with the occurrence of PC. CONCLUSION: We found an increased risk of PC after LA for ACC. Whether this is related to an inappropriate surgical approach or to insufficient experience in ACC surgery should be clarified by a prospective program.
Adrenal Cortex Neoplasms/pathology/*surgery, Adrenalectomy/*adverse effects, Adrenocortical Carcinoma/secondary/*surgery, Adult, Aged, Female, Humans, Laparoscopy/*adverse effects, Male, Middle Aged, Neoplasm Staging, Patient Selection, Peritoneal Neoplasms/*etiology/*secondary, Retrospective Studies, Treatment Outcome
Last modification date