Outcomes following surgical management of adrenocortical carcinoma: a single-center experience / Resultados después del manejo quirúrgico del carcinoma adrenocortical: una experiencia de un solo centro

ABSTRACT

Objetive Adrenocortical carcinoma(ACC) is a rare and heterogeneous disease, with challenging management and poor prognosis. Surgery withcurative intent is the preferred treatment option for localized disease, with a reported 5-year survival rate of55% for complete resections. However, owing to thehigh risk of recurrence there is a need for adjuvant therapies, such as mitotane, an adrenolytic drug, or irradiation, while in advanced disease the standard of careis a combined chemotherapy scheme. The aim of thisstudy was to report our experience in the surgical management and outcomes of ACC patients. Material and methods: A retrospective observational study was performed in a cohort of ACC patientswho had undergone surgical resection (open or laparoscopic approach) and were followed up at our tertiary hospital. Patients with localized or locally advanced disease were included in the analysis. All medical records,including clinical, surgical, pathologic, and follow-updata, were collected and analyzed. Results: A total of 19 ACC patients were managedat our center between August 1990 and August 2013.The median age at diagnosis was 50.5 years (range19–72), and most patients were males. Abdominalpain was the most common clinical presentation (n=9,47.4%). Abdominal contrast-enhanced computed tomography (CT) was performed in all cases. Only 3 tu-mors (15.8%) were functional and most were stage II atdiagnosis (n=9, 47.4%). No patient presented metastasis. Of the 19 patients, 18 (94.7%) underwent surgerywith curative intent, while one (5.3%) received adjuvantradiotherapy (ART). The open approach was used in17 patients (89.5%), while the remaining 2 (10.5%)underwent laparoscopy. Postoperative complicationsoccurred in 8 patients (42.1%); none were of grade IVor V. Median follow-up was 66 months (range 3–312).The majority of patients (n=15, 78.9%) were diseasefree with surgery alone. None received adjuvant mitotane therapy...(AU)

RESUMEN

Objetivo: El carcinoma adrenocorticales una enfermedad heterogénea y rara que conllevaun manejo complicado y cuyo pronóstico es malo. Anteuna enefermedad localizada el manejo quirúrgico es deelección, observando una tasa de supervivencia a los 5años del 55% en resecciones completas. Sin embargo,debido a la alta tasa de recurrencias, se requiere complementar el manejo con una terapia adyuvante comoes el caso del mitotane, un agente adrenolítico, o laradioterapia. En casos de enfermedad avanzada la terapia de elección incluye una pauta de quimioterapiacombinada. El objetivo del presente estudio es reportarnuestra experiencia en el manejo quirúrgico y resultadosobtenidos de los pacientes con diagnóstico de carcinoma adrenocortical. Materiales y métodos: Se realizó un estudio observacional de una cohorte de pacientes diagnosticados de carconinoma adrenocortical que requirieronun manejo quirúrgico (abierto o laparoscópico) y querealizaron su seguimiento en nuestro hospital terciario.Se incluyó a pacientes con enfermedad localizada ylocalmente avanzada en el análisis. Todos los dados clínicos, quirúrgicos, patológicos y de seguimiento fueronrecolectados para el análisis. Resultados: Entre agosto del 1990 y agosto del2013 un total de 19 pacientes diagnosticados decarcinoma adrenocortical fueron tratados en nuestrocentro. La mediana de edad al diagnóstico fue 50,5años (rango 19-72), siendo la mayoría hombres. Elsíntoma inicial mas frecuente fue el dolor abdominal(n=9, 47,4%). Una tomografía computarizada con contraste fue realizada en todos los casos. Sólo 3 tumores(15,8%) eran funcionales y la mayoría correspondíaa un estadio II al diagnóstico (n=9, 47,4%). Ningúnpaciente presentaba metástasis. De los 19 pacientes,18 (94,7%) requirieron cirugía con intención curativa,mientras que a uno (5,3%) se le realizó radioterapiaadyuvante...(AU)