Surgery in adrenocortical carcinoma; importance of national cooperation and centralized surgery
I G C Hermsen1, T M A Kerkhofs1, G Den Butter1, J Kievit2, C Eijck3, E Nieveen van Dijkum4 & H R Haak1
Introduction: The low incidence rate of adrenocortical carcinoma requires a multidisciplinary approach in which specialised surgery has an essential role as complete resection of the primary tumour is the only chance of cure.
In order to improve patient care, insight into surgical results within the ACC population is essential. In 2007, a Dutch Adrenal Network Registry has been created encompassing care and outcome of patients treated for ACC in The Netherlands since 1965. Using this database a study was performed with the following objectives: i) to gain insight into surgical performance in The Netherlands, ii) to compare surgical data with international literature.
Patients and methods: The data of 175 patients treated from 1965 until January 2008, were studied. The following data were collected; age, gender, functionality of the tumour, stage at diagnosis (ENS@T staging), surgical procedure, completeness of surgery, disease recurrence, adjuvant mitotane therapy, recurrence free survival and overall survival.
Results: One hundred and forty-nine patients were operated. Patients with complete resection had significantly longer survival than patients with incomplete resection (P=0.01). Patients operated in a Dutch Adrenal Network centre had significantly longer survival in both univariate (P=0.01) and multivariate analysis (P=0.01). Significant longer survival was observed in operated stage IV patients compared to non-operated patients (P=0.00).
Conclusion: Our data confirm the relevance of national cooperation and centralized surgery in ACC. In selected patients with stage 4 disease surgery can be beneficial in extending survival. On the basis of the retrospective analysis surgery in The Netherlands will and can be improved.