Il trattamento chirurgico del carcinoma cortico-surrenalico: la nostra esperienza

Translated title of the contribution: [Autom. eng. transl.] Surgical treatment of cortico-adrenal carcinoma: our experience

Celestino Pio Lombardi, Marco Raffaelli, Carmela De Crea, Rocco Domenico Alfonso Bellantone, Luigi Oragano, Francesco Pennestri'

Research output: Contribution to journalArticle

Abstract

[Autom. eng. transl.] Background Cortico-adrenal carcinoma (adrenocortical carcinoma - ACC) is a rare tumor, characterized by a heterogeneous clinical presentation and a variable but generally poor prognosis. A radical surgical resection represents, to date, the only potentially effective therapy in the treatment of ACC in the initial phase (stages I-II). Purpose of the study The aim of this work is to report our monocentric experience of a consecutive series of ACC, in order to evaluate the results of surgery in the treatment of this tumor. Methods We analyzed the clinical and operative data of 363 patients who underwent adrenalectomy at our OU from 1977 to 2009: 185 with a laparotomic approach, 85 with a lateral transperitoneal laparoscopic approach and 93 with a posterior retroperitoneoscopic approach. The subject of this study is 27 patients, 15 men and 12 women, with an average age of 49.7 ± 16.4 years (range: 18-72) undergoing adrenalectomy for ACC. The surgical approach was laparotomic in 24 and endoscopic in the remaining 3 (lateral transperitoneal laparoscopic approach in 2 and posterior retroperitoneoscopic in 1). In 7 patients (26%) a multi-organ resection was performed. Results The mean operative time was 199.7 ± 86.7 minutes (range: 90-390) for laparotomic operations and 133.3 ± 87.4 minutes (range: 60-230) for endoscopic ones. In the only patient undergoing posterior retroperitoneoscopic adrenalectomy an intra-operative bleeding from a caval lesion was observed, resolved endoscopically. Post-operative complications were observed in 6 patients (25%) who underwent laparotomic surgery (1 pleural effusion, 1 pancreatitis, 2 broncho-pneumonic foci, 1 wound infection and 1 para-aortic lymphocele). On histological examination, the mean dimensions were 126.3 ± 50.5 mm (range: 50-200) in patients undergoing laparotomic adrenalectomy and 55 ± 13.2 mm (range: 45-70) for endoscopic patients. Staging was as follows: 2 stage I patients (both undergoing endoscopic adrenalectomy), 14 at stage II (1 of whom underwent laparoscopic adrenalectomy), 5 at stage III and 6 at stage IV. Follow-up was completed in 21 patients (77.8%). At a median follow-up of 40.7 ± 60.0 months (range: 1-216) absolute and median disease-free survival, calculated using the Kaplan-Meier method, was 45 and 25 months respectively. Conclusions Although radical surgical resection is the only potentially effective treatment for ACC patients, recurrence of the disease remains frequent. In view of the rarity of the pathology, multicentric studies are desirable in order to establish which factors are able to improve the prognosis in terms of recurrence and survival.
Translated title of the contribution[Autom. eng. transl.] Surgical treatment of cortico-adrenal carcinoma: our experience
Original languageItalian
Pages (from-to)173-179
Number of pages7
JournalOSPEDALI D'ITALIA. CHIRURGIA
Volume16
Publication statusPublished - 2010

Keywords

  • Adrenal tumors
  • Adrenalectomy
  • Adrenocortical carcinoma

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