Lymphadenectomy for Adrenocortical Carcinoma

Is There a Therapeutic Benefit?

Jon M. Gerry, Thuy B. Tran, Lauren M. Postlewait, Shishir K. Maithel, Jason D. Prescott, Tracy S. Wang, Jason A. Glenn, John E. Phay, Kara Keplinger, Ryan C. Fields, Linda X. Jin, Sharon M. Weber, Ahmed Salem, Jason K. Sicklick, Shady Gad, Adam C. Yopp, John C. Mansour, Quan Yang Duh, Natalie Seiser, Carmen C. Solorzano & 8 others Colleen M. Kiernan, Konstantinos I. Votanopoulos, Edward A. Levine, Ioannis Hatzaras, Rivfka Shenoy, Timothy M. Pawlik, Jeffrey A. Norton, George A. Poultsides

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: Lymph node metastasis is an established predictor of poor outcome for adrenocortical carcinoma (ACC); however, routine lymphadenectomy during surgical resection of ACC is not widely performed and its therapeutic role remains unclear. Methods: Patients undergoing margin-negative resection for localized ACC were identified from a multi-institutional database. Patients were stratified into 2 groups based on the surgeon’s effort or not to perform a lymphadenectomy as documented in the operative note. Clinical, pathologic, and outcome data were compared between the 2 groups. Results: Of 120 patients who met inclusion criteria from 1993 to 2014, 32 (27 %) underwent lymphadenectomy. Factors associated with lymphadenectomy were tumor size (12 vs. 9.5 cm; p = .007), palpable mass at presentation (26 vs. 12 %; p = .07), suspicious lymph nodes on preoperative imaging (44 vs. 7 %; p < .001), and need for multivisceral resection (78 vs. 36 %; p < .001). Median number of lymph nodes harvested was higher in the lymphadenectomy group (5.5 vs. 0; p < .001). In-hospital mortality (0 vs. 1.3 %; p = .72) and grade 3/4 complication rates (0 vs. 12 %; p = .061) were not significantly different. Patients who underwent lymphadenectomy had improved overall survival (5-year 76 vs. 59 %; p = .041). The benefit of lymphadenectomy on overall survival persisted on multivariate analysis (HR = 0.17; p = .006) controlling for adverse preoperative and intraoperative factors associated with lymphadenectomy, such as tumor size, palpable mass, irregular tumor edges, suspicious nodes on imaging, and multivisceral resection. Conclusions: In this multicenter study of adrenocortical carcinoma patients undergoing R0 resection, the surgeon’s effort to dissect peritumoral lymph nodes was independently associated with improved overall survival.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalAnnals of Surgical Oncology
DOIs
StateAccepted/In press - Sep 2 2016

Fingerprint

Adrenocortical Carcinoma
Lymph Node Excision
Lymph Nodes
Therapeutics
Survival
Neoplasms
Hospital Mortality
Multicenter Studies
Multivariate Analysis
Databases
Neoplasm Metastasis

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Gerry, J. M., Tran, T. B., Postlewait, L. M., Maithel, S. K., Prescott, J. D., Wang, T. S., ... Poultsides, G. A. (Accepted/In press). Lymphadenectomy for Adrenocortical Carcinoma: Is There a Therapeutic Benefit? Annals of Surgical Oncology, 1-6. https://doi.org/10.1245/s10434-016-5536-1

Lymphadenectomy for Adrenocortical Carcinoma : Is There a Therapeutic Benefit? / Gerry, Jon M.; Tran, Thuy B.; Postlewait, Lauren M.; Maithel, Shishir K.; Prescott, Jason D.; Wang, Tracy S.; Glenn, Jason A.; Phay, John E.; Keplinger, Kara; Fields, Ryan C.; Jin, Linda X.; Weber, Sharon M.; Salem, Ahmed; Sicklick, Jason K.; Gad, Shady; Yopp, Adam C.; Mansour, John C.; Duh, Quan Yang; Seiser, Natalie; Solorzano, Carmen C.; Kiernan, Colleen M.; Votanopoulos, Konstantinos I.; Levine, Edward A.; Hatzaras, Ioannis; Shenoy, Rivfka; Pawlik, Timothy M.; Norton, Jeffrey A.; Poultsides, George A.

In: Annals of Surgical Oncology, 02.09.2016, p. 1-6.

Research output: Contribution to journalArticle

Gerry, JM, Tran, TB, Postlewait, LM, Maithel, SK, Prescott, JD, Wang, TS, Glenn, JA, Phay, JE, Keplinger, K, Fields, RC, Jin, LX, Weber, SM, Salem, A, Sicklick, JK, Gad, S, Yopp, AC, Mansour, JC, Duh, QY, Seiser, N, Solorzano, CC, Kiernan, CM, Votanopoulos, KI, Levine, EA, Hatzaras, I, Shenoy, R, Pawlik, TM, Norton, JA & Poultsides, GA 2016, 'Lymphadenectomy for Adrenocortical Carcinoma: Is There a Therapeutic Benefit?', Annals of Surgical Oncology, pp. 1-6. https://doi.org/10.1245/s10434-016-5536-1
Gerry, Jon M. ; Tran, Thuy B. ; Postlewait, Lauren M. ; Maithel, Shishir K. ; Prescott, Jason D. ; Wang, Tracy S. ; Glenn, Jason A. ; Phay, John E. ; Keplinger, Kara ; Fields, Ryan C. ; Jin, Linda X. ; Weber, Sharon M. ; Salem, Ahmed ; Sicklick, Jason K. ; Gad, Shady ; Yopp, Adam C. ; Mansour, John C. ; Duh, Quan Yang ; Seiser, Natalie ; Solorzano, Carmen C. ; Kiernan, Colleen M. ; Votanopoulos, Konstantinos I. ; Levine, Edward A. ; Hatzaras, Ioannis ; Shenoy, Rivfka ; Pawlik, Timothy M. ; Norton, Jeffrey A. ; Poultsides, George A. / Lymphadenectomy for Adrenocortical Carcinoma : Is There a Therapeutic Benefit?. In: Annals of Surgical Oncology. 2016 ; pp. 1-6.
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abstract = "Background: Lymph node metastasis is an established predictor of poor outcome for adrenocortical carcinoma (ACC); however, routine lymphadenectomy during surgical resection of ACC is not widely performed and its therapeutic role remains unclear. Methods: Patients undergoing margin-negative resection for localized ACC were identified from a multi-institutional database. Patients were stratified into 2 groups based on the surgeon’s effort or not to perform a lymphadenectomy as documented in the operative note. Clinical, pathologic, and outcome data were compared between the 2 groups. Results: Of 120 patients who met inclusion criteria from 1993 to 2014, 32 (27 {\%}) underwent lymphadenectomy. Factors associated with lymphadenectomy were tumor size (12 vs. 9.5 cm; p = .007), palpable mass at presentation (26 vs. 12 {\%}; p = .07), suspicious lymph nodes on preoperative imaging (44 vs. 7 {\%}; p < .001), and need for multivisceral resection (78 vs. 36 {\%}; p < .001). Median number of lymph nodes harvested was higher in the lymphadenectomy group (5.5 vs. 0; p < .001). In-hospital mortality (0 vs. 1.3 {\%}; p = .72) and grade 3/4 complication rates (0 vs. 12 {\%}; p = .061) were not significantly different. Patients who underwent lymphadenectomy had improved overall survival (5-year 76 vs. 59 {\%}; p = .041). The benefit of lymphadenectomy on overall survival persisted on multivariate analysis (HR = 0.17; p = .006) controlling for adverse preoperative and intraoperative factors associated with lymphadenectomy, such as tumor size, palpable mass, irregular tumor edges, suspicious nodes on imaging, and multivisceral resection. Conclusions: In this multicenter study of adrenocortical carcinoma patients undergoing R0 resection, the surgeon’s effort to dissect peritumoral lymph nodes was independently associated with improved overall survival.",
author = "Gerry, {Jon M.} and Tran, {Thuy B.} and Postlewait, {Lauren M.} and Maithel, {Shishir K.} and Prescott, {Jason D.} and Wang, {Tracy S.} and Glenn, {Jason A.} and Phay, {John E.} and Kara Keplinger and Fields, {Ryan C.} and Jin, {Linda X.} and Weber, {Sharon M.} and Ahmed Salem and Sicklick, {Jason K.} and Shady Gad and Yopp, {Adam C.} and Mansour, {John C.} and Duh, {Quan Yang} and Natalie Seiser and Solorzano, {Carmen C.} and Kiernan, {Colleen M.} and Votanopoulos, {Konstantinos I.} and Levine, {Edward A.} and Ioannis Hatzaras and Rivfka Shenoy and Pawlik, {Timothy M.} and Norton, {Jeffrey A.} and Poultsides, {George A.}",
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T1 - Lymphadenectomy for Adrenocortical Carcinoma

T2 - Is There a Therapeutic Benefit?

AU - Gerry, Jon M.

AU - Tran, Thuy B.

AU - Postlewait, Lauren M.

AU - Maithel, Shishir K.

AU - Prescott, Jason D.

AU - Wang, Tracy S.

AU - Glenn, Jason A.

AU - Phay, John E.

AU - Keplinger, Kara

AU - Fields, Ryan C.

AU - Jin, Linda X.

AU - Weber, Sharon M.

AU - Salem, Ahmed

AU - Sicklick, Jason K.

AU - Gad, Shady

AU - Yopp, Adam C.

AU - Mansour, John C.

AU - Duh, Quan Yang

AU - Seiser, Natalie

AU - Solorzano, Carmen C.

AU - Kiernan, Colleen M.

AU - Votanopoulos, Konstantinos I.

AU - Levine, Edward A.

AU - Hatzaras, Ioannis

AU - Shenoy, Rivfka

AU - Pawlik, Timothy M.

AU - Norton, Jeffrey A.

AU - Poultsides, George A.

PY - 2016/9/2

Y1 - 2016/9/2

N2 - Background: Lymph node metastasis is an established predictor of poor outcome for adrenocortical carcinoma (ACC); however, routine lymphadenectomy during surgical resection of ACC is not widely performed and its therapeutic role remains unclear. Methods: Patients undergoing margin-negative resection for localized ACC were identified from a multi-institutional database. Patients were stratified into 2 groups based on the surgeon’s effort or not to perform a lymphadenectomy as documented in the operative note. Clinical, pathologic, and outcome data were compared between the 2 groups. Results: Of 120 patients who met inclusion criteria from 1993 to 2014, 32 (27 %) underwent lymphadenectomy. Factors associated with lymphadenectomy were tumor size (12 vs. 9.5 cm; p = .007), palpable mass at presentation (26 vs. 12 %; p = .07), suspicious lymph nodes on preoperative imaging (44 vs. 7 %; p < .001), and need for multivisceral resection (78 vs. 36 %; p < .001). Median number of lymph nodes harvested was higher in the lymphadenectomy group (5.5 vs. 0; p < .001). In-hospital mortality (0 vs. 1.3 %; p = .72) and grade 3/4 complication rates (0 vs. 12 %; p = .061) were not significantly different. Patients who underwent lymphadenectomy had improved overall survival (5-year 76 vs. 59 %; p = .041). The benefit of lymphadenectomy on overall survival persisted on multivariate analysis (HR = 0.17; p = .006) controlling for adverse preoperative and intraoperative factors associated with lymphadenectomy, such as tumor size, palpable mass, irregular tumor edges, suspicious nodes on imaging, and multivisceral resection. Conclusions: In this multicenter study of adrenocortical carcinoma patients undergoing R0 resection, the surgeon’s effort to dissect peritumoral lymph nodes was independently associated with improved overall survival.

AB - Background: Lymph node metastasis is an established predictor of poor outcome for adrenocortical carcinoma (ACC); however, routine lymphadenectomy during surgical resection of ACC is not widely performed and its therapeutic role remains unclear. Methods: Patients undergoing margin-negative resection for localized ACC were identified from a multi-institutional database. Patients were stratified into 2 groups based on the surgeon’s effort or not to perform a lymphadenectomy as documented in the operative note. Clinical, pathologic, and outcome data were compared between the 2 groups. Results: Of 120 patients who met inclusion criteria from 1993 to 2014, 32 (27 %) underwent lymphadenectomy. Factors associated with lymphadenectomy were tumor size (12 vs. 9.5 cm; p = .007), palpable mass at presentation (26 vs. 12 %; p = .07), suspicious lymph nodes on preoperative imaging (44 vs. 7 %; p < .001), and need for multivisceral resection (78 vs. 36 %; p < .001). Median number of lymph nodes harvested was higher in the lymphadenectomy group (5.5 vs. 0; p < .001). In-hospital mortality (0 vs. 1.3 %; p = .72) and grade 3/4 complication rates (0 vs. 12 %; p = .061) were not significantly different. Patients who underwent lymphadenectomy had improved overall survival (5-year 76 vs. 59 %; p = .041). The benefit of lymphadenectomy on overall survival persisted on multivariate analysis (HR = 0.17; p = .006) controlling for adverse preoperative and intraoperative factors associated with lymphadenectomy, such as tumor size, palpable mass, irregular tumor edges, suspicious nodes on imaging, and multivisceral resection. Conclusions: In this multicenter study of adrenocortical carcinoma patients undergoing R0 resection, the surgeon’s effort to dissect peritumoral lymph nodes was independently associated with improved overall survival.

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