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<p>In locally advanced adrenocortical carcinoma (ACC) (ENSAT stage III – S-III) R0 surgery, involving <i>en bloc</i> extended resections, is the only potential curative treatment. We evaluated oncological outcomes and complications rate in S-III patients who underwent extended resection in comparison with stage I/II (S-I/II). Among 1098 adrenalectomies over 27&#xa0;years (1997 –2024) in a tertiary referral center, medical records of ACC patients were reviewed, excluding stage IV and not-multivisceral resections in S-III patients. Forty-eight patients met the inclusion criteria: 6 S-I (12.5%), 36 S-II (75%) and 6 S-III (12.5%) patients. The latter patients’ cohort underwent multivisceral <i>en bloc</i> resections (3 total nephrectomies, one renal vein thrombectomy, one splenopancreasectomy associated with total nephrectomy, left hemicolectomy and omentectomy, one liver S6-S7-S8 resection). Open adrenalectomy was scheduled in all S-III patients. Minimally-invasive approach was scheduled in 21 (50%) S-I/II patients. Conversion to open adrenalectomy was registered in 5 out these 21 patients. Locoregional and distant disease recurrences were registered in 19% of S-I/II vs 33.3% of S-III patients and 28.6% of S-I/II vs 66.7% of S-III patients, respectively (<i>p</i> = 0.420, <i>p</i> = 0.064). Postoperative complications were observed in 21.4% of S-I/II patients and 16.7% of S-III patients (<i>p</i> = 0.788). Kaplan–Meier DFS and OS curves were comparable among the two groups (<i>p</i> = 0.255, <i>p</i> = 0.459, respectively). After univariable analysis, hyperfunction and chemotherapy were significantly associated with locoregional disease recurrence (<i>p</i> = 0.02, <i>p</i> = 0.04, respectively). OS and DFS of S-III ACC patients undergoing extended <i>en bloc</i> R0 resections were comparable to those of S-I/II patients, without increased postoperative morbidity.</p>

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Impact of en bloc extended R0 resections on oncological outcome of locally advanced adrenocortical carcinoma

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  • 发表日期：

    2025年5月3日

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  • Priscilla Francesca Procopio,
  • Francesco Pennestrì,
  • Antonio Laurino,
  • Esther Diana Rossi,
  • Giovanni Schinzari,
  • Alfredo Pontecorvi,
  • Carmela De Crea,
  • Marco Raffaelli

摘要

In locally advanced adrenocortical carcinoma (ACC) (ENSAT stage III – S-III) R0 surgery, involving en bloc extended resections, is the only potential curative treatment. We evaluated oncological outcomes and complications rate in S-III patients who underwent extended resection in comparison with stage I/II (S-I/II). Among 1098 adrenalectomies over 27 years (1997 –2024) in a tertiary referral center, medical records of ACC patients were reviewed, excluding stage IV and not-multivisceral resections in S-III patients. Forty-eight patients met the inclusion criteria: 6 S-I (12.5%), 36 S-II (75%) and 6 S-III (12.5%) patients. The latter patients’ cohort underwent multivisceral en bloc resections (3 total nephrectomies, one renal vein thrombectomy, one splenopancreasectomy associated with total nephrectomy, left hemicolectomy and omentectomy, one liver S6-S7-S8 resection). Open adrenalectomy was scheduled in all S-III patients. Minimally-invasive approach was scheduled in 21 (50%) S-I/II patients. Conversion to open adrenalectomy was registered in 5 out these 21 patients. Locoregional and distant disease recurrences were registered in 19% of S-I/II vs 33.3% of S-III patients and 28.6% of S-I/II vs 66.7% of S-III patients, respectively (p = 0.420, p = 0.064). Postoperative complications were observed in 21.4% of S-I/II patients and 16.7% of S-III patients (p = 0.788). Kaplan–Meier DFS and OS curves were comparable among the two groups (p = 0.255, p = 0.459, respectively). After univariable analysis, hyperfunction and chemotherapy were significantly associated with locoregional disease recurrence (p = 0.02, p = 0.04, respectively). OS and DFS of S-III ACC patients undergoing extended en bloc R0 resections were comparable to those of S-I/II patients, without increased postoperative morbidity.