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Operative approach and case volume are associated with negative resection margins for adrenocortical carcinoma

  • 2021 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Surgical resection with negative margins is the treatment of choice for adrenocortical carcinoma (ACC). This study was undertaken to determine factors associated with negative resection margins.

Methods

National Cancer Database was queried from 2010 to 2016 to identify patients with AJCC/ENSAT Stage I–III ACC who underwent adrenalectomy. Patient, tumor, facility, and operative characteristics were compared by margin status (positive—PM or negative—NM) and operative approach (open—OA, laparoscopic—LA, or robotic—RA). Multivariable logistic regression was used to identify factors associated with PM.

Results

Eight hundred and eighty-one patients were identified, of which 18.4% had PM and 81.6% had NM. Patients with advanced pathologic T stage and pathologic N1 stage were more likely to have PM (vs. NM) (T3, 49.7% vs. 24.8%, p < 0.01; T4, 26.2% vs. 10.0%, p < 0.01; N1, 6.7% vs. 3.5%, p < 0.01). Patients undergoing OA (vs. LA and RA) were more likely to have advanced clinical T stage (T4, 16.6% vs. 5.7% vs. 7.8%, p < 0.01) and larger tumors (> 6 cm, 84.6% vs. 64.1% vs. 62.3%, p < 0.01). High-volume centers (≥ 5 cases) were more likely to utilize OA. Patients undergoing LA (vs. RA) were more likely to require conversion to open (20.3% vs. 7.8%, p = 0.011). On multivariable analysis, factors associated with higher odds of PM included T3 disease (OR 7.02, 95% CI 2.66–18.55), T4 disease (OR 10.22, 95% CI 3.66–28.53), and LA (OR 1.99, 95% CI 1.28–3.09). High-volume centers were associated with lower odds of PM (OR 0.67, 95% CI 0.45–0.98). There was no significant difference in margin status between OA and RA (OR 1.44, 95% CI 0.71–2.90).

Conclusion

Centers with higher ACC case volumes have lower odds of PM and utilize OA more often. LA is associated with higher odds of PM, whereas RA is not. These factors should be considered when planning the operative approach for ACC.

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Authors and Affiliations

  1. Division of Minimally Invasive Surgery and Endocrine Surgery, Department of Surgery, Cedars-Sinai Medical Center, 8635 W. 3rd St., Suite 650, Los Angeles, CA, 90048, USA

    Joshua Tseng, Timothy Diperi, Nicholas Gonsalves, Yufei Chen, Daniel Shouhed, Edward Phillips, Miguel Burch & Monica Jain

  2. Department of Surgery, Kern Medical, Bakersfield, CA, USA

    Joshua Tseng

  3. Adrenal Program, Pituitary Center, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Anat Ben-Shlomo

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  1. Joshua Tseng
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Correspondence to Monica Jain.

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Disclosures

Drs. Tseng, Diperi, Gonsalves, Chen, Ben-Shlomo, Shouhed, Phillips, Burch, and Jain have no conflicts of interest or financial ties to disclose.

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Tseng, J., Diperi, T., Gonsalves, N. et al. Operative approach and case volume are associated with negative resection margins for adrenocortical carcinoma. Surg Endosc 36, 9288–9296 (2022). https://doi.org/10.1007/s00464-022-09167-0

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  • DOI: https://doi.org/10.1007/s00464-022-09167-0

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