Adrenocortical carcinoma: effect of hospital volume on patient outcome

Celestino Pio Lombardi, Marco Raffaelli, Carmela De Crea, Rocco Domenico Alfonso Bellantone, M Boniardi, G De Toma, La Marzano, P Miccoli, F Minni, M Morino, Mr Pelizzo, A Pietrabissa, A Renda, A Valeri

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

PURPOSE: Optimal management of adrenocortical carcinoma (ACC) involves a detailed diagnostic workup, radical surgery, and appropriate adjuvant therapy. However, due to the rarity of this disease, adequate expertise is necessary to ensure optimal patient care. We evaluated if the experience of a treating center influences the outcome of ACC. METHODS: Two hundred sixty-three patients who underwent adrenalectomy for ACC were included in a multi-institutional surgical survey and divided into 2 groups: "high-volume center" (HVC) (≥10 adrenalectomies for ACC) and "low-volume center" (LVC) (<10 adrenalectomies for ACC). A comparative analysis was performed. RESULTS: One hundred seventy-two patients underwent adrenalectomy at HVC and 91 at LVC. The two groups were homogeneous for age, sex, clinical presentation, and stage. The mean lesions size of ACC was higher in HVC than in LVC (104.1 ± 54.6 vs 82.8 ± 41.3 mm; P < 0.001). A significantly higher rate of lymph node dissection (P < 0.01) and of multiorgan resection (P < 0.01) was accomplished in HVC. The number of patients who underwent adjuvant therapy was significantly higher in HVC (P < 0.001). Local recurrence rate was lower in patients treated at HVC (6% vs 18.5%; P = NS). Mean time to recurrence was significantly longer in HVC than in LVC (25.2 ± 28.1 vs 10.1 ± 7.5; P < 0.01). CONCLUSION: The expertise of dedicated centers had a positive impact on the outcome of patients with ACC, resulting in a lower recurrence rate and improved mean time to recurrence. The improved patient outcome could be related not only to the appropriateness of the surgical procedure, but also to a more adequate multidisciplinary approach.
Original languageEnglish
Pages (from-to)201-207
Number of pages7
JournalLANGENBECK'S ARCHIVES OF SURGERY
Volume397
DOIs
Publication statusPublished - 2012

Keywords

  • Adolescent
  • Adrenal Cortex Neoplasms
  • Adrenalectomy
  • Adrenocortical Carcinoma
  • Adult
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Child
  • Cross-Sectional Studies
  • Female
  • Hospitals
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Neoplasm Invasiveness
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Prognosis
  • Quality of Health Care
  • Statistics, Nonparametric
  • Survival Analysis
  • Treatment Outcome
  • Workload
  • Young Adult

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