Elsevier

The Annals of Thoracic Surgery

Volume 92, Issue 6, December 2011, Pages 1965-1970
The Annals of Thoracic Surgery

Original article
General thoracic
Metastatic Adrenocortical Carcinoma: Results of 56 Pulmonary Metastasectomies in 24 Patients

https://doi.org/10.1016/j.athoracsur.2011.07.088Get rights and content

Background

Surgical resection is an important form of treatment for metastatic disease in patients with adrenocortical carcinoma (ACC). However, data about the results of this treatment are sparse. We reviewed our experience with the resection of pulmonary lesions metastatic from ACC as a means of evaluating such results.

Methods

A retrospective review of the database at a German national registry for ACC identified 24 patients (9 men and 15 women; median age, 41 years) who underwent pulmonary metastasectomy for primary ACC during the study period of 1989 through 2009. Only patients who met the criteria for potentially curative surgery, defined as the presumed feasibility of resecting all visualized tumorous lesions, were included.

Results

No perioperative deaths occurred in 56 pulmonary metastasectomies done on the patients in the study. The overall cumulative rate of 5-year survival, calculated from the time of first pulmonary surgery, was 24.5%, and the median survival was 50.2 months. Age younger than 41 years at the time of first pulmonary metastasectomy and repeated pulmonary metastasectomy were associated with longer survival in a univariate analysis. In accord with this, we observed a median survival of 31.9 months in patients 41 years of age or older as compared with a median survival of 59.3 months in younger patients (p = 0.004). In patients with repeated pulmonary metastasectomies, median survival after the first resection was significantly longer, at 59.3 months than in patients who had only one pulmonary resection, whose median survival was 31.9 months (p = 0.001).

Conclusions

We conclude that surgical resection of pulmonary metastases for ACC should be regarded as safe, with the potential for producing long-term survival in a highly selected group of patients. Younger patients may benefit more than older ones from such resection, and the recurrence of pulmonary metastases should not preclude repeated surgical resections of these lesions.

Section snippets

Patients and Methods

Between 1989 and 2009, 24 patients in 15 departments of thoracic surgery at centers in Germany and Austria underwent pulmonary resection of metastatic ACC, of whom 7 patients were in the Department of Thoracic Surgery at the University Hospital in Heidelberg, Germany. They were followed postoperatively and their clinical data were retrieved by the German Adrenocortical Carcinoma Registry in Würzburg, Germany. This registry is a nationwide data base established in 2003 by the interdisciplinary

Results

The 30-day postoperative mortality in the study was 0%, and no patient required repeat thoracotomy for postoperative complications within the first 24 hours after initial metastasectomy. The mean period of follow-up of surviving patients (censored patients) after the resection of a primary tumor was 109 months (range, 19 to 193 months), and after pulmonary metastasectomy was 63 months (range, 8 to 147 months). The cumulative 5-year survival of all of the patients in the study after resection of

Comment

Adrenocortical carcinoma is an uncommon and aggressive disease, and at the time of its diagnosis about one third of patients with ACC present with metastatic disease [10]. Brennan and colleagues [11] have reported that metastases occur in 70% of patients with ACC and most often involve the lungs (45%), liver (42%), lymph nodes (24%), and bone (15%). The 5-year survival of patients with distant metastases of ACC has been reported to range from 0 to 17% [12, 13, 14], with a median survival of

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