Original articleGeneral thoracicMetastatic Adrenocortical Carcinoma: Results of 56 Pulmonary Metastasectomies in 24 Patients
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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Cited by (32)
Surgery for adrenocortical carcinoma: When and how?
2020, Best Practice and Research: Clinical Endocrinology and MetabolismCitation Excerpt :Pulmonary ACC metastases that are reasonably accessible may be surgically removed, as well. Op den Winkel et al. described the outcomes of 56 pulmonary metastasectomies with a median survival of 50 months and a five-year survival of 24.5% [61]. Kemp and colleagues also reported similar results after 60 pulmonary metastasectomies, ranging from wedge resection to pneumonectomy, with a median survival of 40 months and five-year actuarial survival of 41% [62].
Advances in the diagnosis and management of adrenocortical carcinoma
2019, Advances in Treatment and Management in Surgical EndocrinologyLongitudinal patterns of recurrence in patients with adrenocortical carcinoma
2019, Surgery (United States)A phase II trial of cytoreduction and hyperthermic intraperitoneal chemotherapy for recurrent adrenocortical carcinoma
2018, Journal of Surgical ResearchCitation Excerpt :The FIRM-ACT trial demonstrated no difference in overall survival between patients who were treated with streptozocin-mitotane compared to combination chemotherapy (etoposide, doxorubicin, cisplatin, mitotane; 12 versus 13.8 mo). Prior surgical studies evaluating pulmonary metastasectomy for limited oligometastatic disease have reported overall survival rates ranging from 27 to 50.2 mo.9-12,23 Median overall survival had not yet been reached at the time of this analysis (median length of follow-up: 23 mo). While definitive conclusions regarding overall survival benefit from cytoreduction and HIPEC cannot be made, it appears that this intervention may be combined with systemic chemotherapy to offer improved survival.
Clinical Score Predicting Long-Term Survival after Repeat Resection for Recurrent Adrenocortical Carcinoma
2016, Journal of the American College of SurgeonsCitation Excerpt :However, recurrent ACC eventually developed in all 28 patients, who died of disease during follow-up.15 On the contrary, results of pulmonary metastasectomy for ACC appear more encouraging, with a German study of 24 patients showing that complete resection of pulmonary metastases was associated with a considerable median survival of 50 months.16 The impact of margin status on survival after recurrent ACC resection remains a subject of debate.
Adrenocortical Carcinoma
2015, Endocrinology: Adult and Pediatric