Georgios Antonios Margonis1, Neda Amini1, Yuhree Kim1, Thuy B Tran2, Lauren M Postlewait3, Shishir K Maithel3, Tracy S Wang4, Douglas B Evans4, Ioannis Hatzaras5, Rivfka Shenoy5, John E Phay6, Kara Keplinger6, Ryan C Fields7, Lindsey E Moses7, Sharon M Weber8, Ahmed Salem8, Jason K Sicklick9, Shady Gad9, Adam C Yopp10, John C Mansour10, Quan-Yang Duh11, Natalie Seiser11, Carmen C Solorzano12, Colleen M Kiernan12, Konstantinos I Votanopoulos13, Edward A Levine13, George A Poultsides2, Timothy M Pawlik1. 1. Department of Surgery, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD 21287, USA. 2. Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA. 3. Department of Surgery, Emory University, Atlanta, GA, USA. 4. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. 5. Department of Surgery, New York University School of Medicine, New York, NY, USA. 6. Department of Surgery, The Ohio State University, Columbus, OH, USA. 7. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA. 8. Department of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. 9. Department of Surgery, University of California San Diego, San Diego, CA, USA. 10. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. 11. Department of Surgery, University of California San Francisco, San Francisco, CA, USA. 12. Department of Surgery, Vanderbilt University, Nashville, TN, USA. 13. Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Abstract
BACKGROUND: The association of postoperative complications with long-term oncologic outcomes remains unclear. We sought to determine the incidence of complications among patients who underwent surgery for adrenocortical carcinoma (ACC) and define the relationship of morbidity with long-term survival. METHODS: Patients who underwent surgery for ACC between 1993 and 2014 were identified from 13 academic institutions participating in the US ACC group study. The incidence and type of the postoperative complications, the factors associated with them as well their association with long-term survival were analyzed. RESULTS: A total of 265 patients with median age of 52 years (IQR 44-63) were identified; at surgery, the majority of patients underwent an open abdominal procedure (n = 169, 66.8%). A postoperative complication occurred in 99 patients for a morbidity of 37.4%; five patients (1.9%) died in hospital. Factors associated with morbidity included a thoraco-abdominal operative approach (reference: open abdominal; OR 2.85, 95% CI 1.00-8.18), and a hormonally functional tumor (OR 3.56, 95% CI 1.65-7.69) (all P < 0.05). Presence of any complication was associated with a worse long-term outcome (median survival: no complication, 58.9 months vs. any complication, 25.1 months; P = 0.009). In multivariate analysis, after adjusting for patient- and disease-related factors postoperative infectious complications independently predicted shorter overall survival (hazard ratio (HR) 5.56, 95% CI 2.24-13.80; P < 0.001). CONCLUSION: Postoperative complications were independently associated with decreased long-term survival after resection for ACC. The prevention of complications may be important from an oncologic perspective.
BACKGROUND: The association of postoperative complications with long-term oncologic outcomes remains unclear. We sought to determine the incidence of complications among patients who underwent surgery for adrenocortical carcinoma (ACC) and define the relationship of morbidity with long-term survival. METHODS:Patients who underwent surgery for ACC between 1993 and 2014 were identified from 13 academic institutions participating in the US ACC group study. The incidence and type of the postoperative complications, the factors associated with them as well their association with long-term survival were analyzed. RESULTS: A total of 265 patients with median age of 52 years (IQR 44-63) were identified; at surgery, the majority of patients underwent an open abdominal procedure (n = 169, 66.8%). A postoperative complication occurred in 99 patients for a morbidity of 37.4%; five patients (1.9%) died in hospital. Factors associated with morbidity included a thoraco-abdominal operative approach (reference: open abdominal; OR 2.85, 95% CI 1.00-8.18), and a hormonally functional tumor (OR 3.56, 95% CI 1.65-7.69) (all P < 0.05). Presence of any complication was associated with a worse long-term outcome (median survival: no complication, 58.9 months vs. any complication, 25.1 months; P = 0.009). In multivariate analysis, after adjusting for patient- and disease-related factors postoperative infectious complications independently predicted shorter overall survival (hazard ratio (HR) 5.56, 95% CI 2.24-13.80; P < 0.001). CONCLUSION: Postoperative complications were independently associated with decreased long-term survival after resection for ACC. The prevention of complications may be important from an oncologic perspective.
Authors: Gaya Spolverato; Mohammad Y Yakoob; Yuhree Kim; Sorin Alexandrescu; Hugo P Marques; Jorge Lamelas; Luca Aldrighetti; T Clark Gamblin; Shishir K Maithel; Carlo Pulitano; Todd W Bauer; Feng Shen; George A Poultsides; J Wallis Marsh; Timothy M Pawlik Journal: Cancer Date: 2015-04-22 Impact factor: 6.860
Authors: Felix Beuschlein; Jens Weigel; Wolfgang Saeger; Matthias Kroiss; Vanessa Wild; Fulvia Daffara; Rosella Libé; Arianna Ardito; Abir Al Ghuzlan; Marcus Quinkler; Andrea Oßwald; Cristina L Ronchi; Ronald de Krijger; Richard A Feelders; Jens Waldmann; Holger S Willenberg; Timo Deutschbein; Anthony Stell; Martin Reincke; Mauro Papotti; Eric Baudin; Frédérique Tissier; Harm R Haak; Paola Loli; Massimo Terzolo; Bruno Allolio; Hans-Helge Müller; Martin Fassnacht Journal: J Clin Endocrinol Metab Date: 2015-01-05 Impact factor: 5.958
Authors: Christina W Lee; Ahmed I Salem; David F Schneider; Glen E Leverson; Thuy B Tran; George A Poultsides; Lauren M Postlewait; Shishir K Maithel; Tracy S Wang; Ioannis Hatzaras; Rivfka Shenoy; John E Phay; Lawrence Shirley; Ryan C Fields; Linda X Jin; Timothy M Pawlik; Jason D Prescott; Jason K Sicklick; Shady Gad; Adam C Yopp; John C Mansour; Quan-Yang Duh; Natalie Seiser; Carmen C Solorzano; Colleen M Kiernan; Konstantinos I Votanopoulos; Edward A Levine; Sharon M Weber Journal: J Gastrointest Surg Date: 2016-10-21 Impact factor: 3.452