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Adrenocortical carcinoma: effect of hospital volume on patient outcome

  • Original Article
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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.

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Acknowledgments

We wish to thank Antonio Ambrosi (University of Foggia), Giuseppe Cucchiara (Hospital “Fatebenefratelli”, Rome), Giorgio Giannone (Hospital “Garibaldi - Nesima”, Catania), Gianluigi Melotti (Baggiovara Hospital, Modena), Fabio Procacciante (University “La Sapienza”, Rome), Emilio Trabucchi (University of Milano, Milan), Franco Uggeri (University of Milano Bicocca, Monza) for participating in and for their contribution in updating the Italian ACC multi-institutional surgical survey.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Division of General and Endocrine Surgery, Università Cattolica del Sacro Cuore, Rome, Italy

    Celestino Pio Lombardi, Marco Raffaelli, Carmela De Crea & Rocco Bellantone

  2. Department of General Surgery and Videolaparoscopy, Niguarda Ca’ Granda Hospital, Milan, Italy

    Marco Boniardi

  3. Division of General Surgery “P. Valdoni”, University “La Sapienza”, Rome, Italy

    Giorgio De Toma

  4. Division of General and Endocrine Surgery, University “Federico II”, Naples, Italy

    Luigi Antonio Marzano

  5. Department of Surgery, University of Pisa, Pisa, Italy

    Paolo Miccoli

  6. Department of Surgery, University “Alma Mater Studiorum”, “S. Orsola-Malpighi” Hospital, Bologna, Italy

    Francesco Minni

  7. Division of Digestive, Colorectal and Minimal Invasive Surgery, University of Turin, Turin, Italy

    Mario Morino

  8. Department of Medical and Surgical Sciences, University of Padua, Padua, Italy

    Maria Rosa Pelizzo

  9. Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy

    Andrea Pietrabissa

  10. Department of Surgery, University “Federico II”, Naples, Italy

    Andrea Renda

  11. Division of General, Emergency and Minimally-Invasive Surgery, Azienda Ospedaliero-Universitaria Careggi SOD, Florence, Italy

    Andrea Valeri

  12. Istituto di Semeiotica Chirurgica, U.O. Chirurgia Generale ed Endocrina, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, L.go A. Gemelli 8, 00168, Rome, Italy

    Marco Raffaelli

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  1. Celestino Pio Lombardi
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  2. Marco Raffaelli
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  3. Marco Boniardi
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  6. Paolo Miccoli
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  7. Francesco Minni
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  8. Mario Morino
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  9. Maria Rosa Pelizzo
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  11. Andrea Renda
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  12. Andrea Valeri
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  13. Carmela De Crea
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  14. Rocco Bellantone
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Corresponding author

Correspondence to Marco Raffaelli.

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Lombardi, C.P., Raffaelli, M., Boniardi, M. et al. Adrenocortical carcinoma: effect of hospital volume on patient outcome. Langenbecks Arch Surg 397, 201–207 (2012). https://doi.org/10.1007/s00423-011-0866-8

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  • DOI: https://doi.org/10.1007/s00423-011-0866-8

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