Danuel V Laan1, Cornelius A Thiels2, Amy Glasgow3, Kevin B Wise1, Geoffrey B Thompson1, Melanie L Richards1, David R Farley1, Mark J Truty1, Travis J McKenzie4. 1. Department of Surgery, Mayo Clinic, Rochester, MN. 2. Department of Surgery, Mayo Clinic, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN. 3. Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN. 4. Department of Surgery, Mayo Clinic, Rochester, MN. Electronic address: Mckenzie.Travis@mayo.edu.
Abstract
BACKGROUND: The safety, efficacy, and prognostic implications of resection of adrenocortical carcinoma with inferior vena cava tumor thrombus are poorly described. METHODS: A retrospective review was performed during a 30-year period on patients who underwent resection of locally advanced, nonmetastatic adrenocortical carcinoma. We compared patients with and without inferior vena cava tumor thrombus, examining perioperative characteristics, completeness of resection, mortality, and survival. RESULTS: We identified 65 patients who underwent resection of locally advanced (T4N0 and T4N1) adrenocortical carcinoma (28 patients with inferior vena cava tumor thrombus, 37 noninferior vena cava tumor thrombus). Rate of complete resection, adjuvant chemotherapy, and short-term postoperative morbidity was similar between groups. Overall survival was similar at 12-months. At 24 months overall survival was less in the inferior vena cava tumor thrombus group (59% vs 30%, P = .04). Differential survival through 60-month follow-up favored the noninferior vena cava tumor thrombus group (36% vs 0%, P = .001). Subgroup analysis including only patients with complete resection demonstrates similar survival at 24-months but at 36-months survival favored the noninferior vena cava tumor thrombus patients (65% vs 29%, P = .047) and this continued through 60 months (40% vs 0%, P = .049). CONCLUSION: Attempt at complete resection of adrenocortical carcinoma with inferior vena cava tumor thrombus seems justified particularly as short-term safety and survival are similar to patients without inferior vena cava tumor thrombus. However, survival beyond 36-months is limited in patients with inferior vena cava tumor thrombus. Patients being evaluated for resection in the setting of inferior vena cava tumor thrombus should be selected carefully.
BACKGROUND: The safety, efficacy, and prognostic implications of resection of adrenocortical carcinoma with inferior vena cava tumor thrombus are poorly described. METHODS: A retrospective review was performed during a 30-year period on patients who underwent resection of locally advanced, nonmetastatic adrenocortical carcinoma. We compared patients with and without inferior vena cava tumor thrombus, examining perioperative characteristics, completeness of resection, mortality, and survival. RESULTS: We identified 65 patients who underwent resection of locally advanced (T4N0 and T4N1) adrenocortical carcinoma (28 patients with inferior vena cava tumor thrombus, 37 noninferior vena cava tumor thrombus). Rate of complete resection, adjuvant chemotherapy, and short-term postoperative morbidity was similar between groups. Overall survival was similar at 12-months. At 24 months overall survival was less in the inferior vena cava tumor thrombus group (59% vs 30%, P = .04). Differential survival through 60-month follow-up favored the noninferior vena cava tumor thrombus group (36% vs 0%, P = .001). Subgroup analysis including only patients with complete resection demonstrates similar survival at 24-months but at 36-months survival favored the noninferior vena cava tumor thrombus patients (65% vs 29%, P = .047) and this continued through 60 months (40% vs 0%, P = .049). CONCLUSION: Attempt at complete resection of adrenocortical carcinoma with inferior vena cava tumor thrombus seems justified particularly as short-term safety and survival are similar to patients without inferior vena cava tumor thrombus. However, survival beyond 36-months is limited in patients with inferior vena cava tumor thrombus. Patients being evaluated for resection in the setting of inferior vena cava tumor thrombus should be selected carefully.
Authors: Paula Marincola Smith; Colleen M Kiernan; Thuy B Tran; Lauren M Postlewait; Shishir K Maithel; Jason Prescott; Timothy Pawlik; Tracy S Wang; Jason Glenn; Ioannis Hatzaras; Rivka Shenoy; John Phay; Lawrence A Shirley; Ryan C Fields; Linda Jin; Sharon Weber; Ahmed Salem; Jason Sicklick; Shady Gad; Adam Yopp; John Mansour; Quan-Yang Duh; Natalie Seiser; Konstantinos Votanopoulos; Edward A Levine; George Poultsides; Carmen C Solórzano Journal: Ann Surg Oncol Date: 2018-06-04 Impact factor: 5.344