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Adrenocortical carcinoma: is the surgical approach a risk factor of peritoneal carcinomatosis?
S Leboulleux1, D Deandreis, A Al Ghuzlan
1Department of Nuclear Medicine and Endocrine Oncology, Institut Gustave Roussy, University Paris Sud-XI, 39 Rue Camille Desmoulins, Villejuif Cedex, France. leboulleux@igr.fr
Context:
Peritoneal carcinomatosis (PC) is a rare site of distant metastases in patients with adrenocortical cancer (ACC). One preliminary study suggests an increased risk of PC after laparoscopic adrenalectomy (LA) for ACC.
Objective:
The objective of the study was to search for risk factors of PC including surgical approach.
Design:
This was a retrospective cohort study conducted in an institutional practice.
Patients:
Sixty-four consecutive patients with ACC seen at our institution between 2003 and 2009 were included. Mean tumor size was 132 mm. Patients had stage I disease in 2 cases, stage II disease in 32 cases, stage III disease in 7 cases, stage IV disease in 21 cases, and unknown stage disease in 2 cases. Surgery was open in 58 cases and laparoscopic in 6 cases.
Main Outcome:
The main outcome was the risk factors of PC.
Results:
PC occurred in 18 (28%) patients. It was present at initial diagnosis in three cases and occurred during follow-up in 15 cases. The only risk factor of PC occurring during follow-up was the surgical approach with a 4-year rate of PC of 67% (95% confidence interval (CI), 30-90%) for LA and 27% (95% CI, 15-44%) for open adrenalectomy (P=0.016). Neither tumor size, stage, functional status, completeness of surgery, nor plasma level of op'DDD was associated with the occurrence of PC.
Conclusion:
We found an increased risk of PC after LA for ACC. Whether this is related to an inappropriate surgical approach or to insufficient experience in ACC surgery should be clarified by a prospective program.
