TY - JOUR
T1 - Adrenocortical carcinoma
T2 - Is the surgical approach a risk factor of peritoneal carcinomatosis?
AU - Leboulleux, S.
AU - Deandreis, D.
AU - Al Ghuzlan, A.
AU - Aupérin, A.
AU - Goéré, D.
AU - Dromain, C.
AU - Elias, D.
AU - Caillou, B.
AU - Travagli, J. P.
AU - De Baere, T.
AU - Lumbroso, J.
AU - Young, J.
AU - Schlumberger, M.
AU - Baudin, E.
PY - 2010/6/1
Y1 - 2010/6/1
N2 - Context: Peritoneal carcinomatosis (PC) is a rare site of distant metastases in patients with adrenocortical cancer (ACC). One preliminary study suggests an increased risk of PC after laparoscopic adrenalectomy (LA) for ACC. Objective: The objective of the study was to search for risk factors of PC including surgical approach. Design: This was a retrospective cohort study conducted in an institutional practice. Patients: Sixty-four consecutive patients with ACC seen at our institution between 2003 and 2009 were included. Mean tumor size was 132 mm. Patients had stage I disease in 2 cases, stage II disease in 32 cases, stage III disease in 7 cases, stage IV disease in 21 cases, and unknown stage disease in 2 cases. Surgery was open in 58 cases and laparoscopic in 6 cases. Main outcome: The main outcome was the risk factors of PC. Results: PC occurred in 18 (28%) patients. It was present at initial diagnosis in three cases and occurred during follow-up in 15 cases. The only risk factor of PC occurring during follow-up was the surgical approach with a 4-year rate of PC of 67% (95% confidence interval (CI), 30-90%) for LA and 27% (95% CI, 15-44%) for open adrenalectomy (P=0.016). Neither tumor size, stage, functional status, completeness of surgery, nor plasma level of op'DDD was associated with the occurrence of PC. Conclusion: We found an increased risk of PC after LA for ACC. Whether this is related to an inappropriate surgical approach or to insufficient experience in ACC surgery should be clarified by a prospective program.
AB - Context: Peritoneal carcinomatosis (PC) is a rare site of distant metastases in patients with adrenocortical cancer (ACC). One preliminary study suggests an increased risk of PC after laparoscopic adrenalectomy (LA) for ACC. Objective: The objective of the study was to search for risk factors of PC including surgical approach. Design: This was a retrospective cohort study conducted in an institutional practice. Patients: Sixty-four consecutive patients with ACC seen at our institution between 2003 and 2009 were included. Mean tumor size was 132 mm. Patients had stage I disease in 2 cases, stage II disease in 32 cases, stage III disease in 7 cases, stage IV disease in 21 cases, and unknown stage disease in 2 cases. Surgery was open in 58 cases and laparoscopic in 6 cases. Main outcome: The main outcome was the risk factors of PC. Results: PC occurred in 18 (28%) patients. It was present at initial diagnosis in three cases and occurred during follow-up in 15 cases. The only risk factor of PC occurring during follow-up was the surgical approach with a 4-year rate of PC of 67% (95% confidence interval (CI), 30-90%) for LA and 27% (95% CI, 15-44%) for open adrenalectomy (P=0.016). Neither tumor size, stage, functional status, completeness of surgery, nor plasma level of op'DDD was associated with the occurrence of PC. Conclusion: We found an increased risk of PC after LA for ACC. Whether this is related to an inappropriate surgical approach or to insufficient experience in ACC surgery should be clarified by a prospective program.
UR - http://www.scopus.com/inward/record.url?scp=77952739887&partnerID=8YFLogxK
U2 - 10.1530/EJE-09-1096
DO - 10.1530/EJE-09-1096
M3 - Article
C2 - 20348273
AN - SCOPUS:77952739887
SN - 0804-4643
VL - 162
SP - 1147
EP - 1153
JO - European Journal of Endocrinology
JF - European Journal of Endocrinology
IS - 6
ER -