Adrenocortical carcinoma with inferior vena cava tumor thrombus

• Published in: Surgery 2017-01, Vol.161 (1), p.240-248
• Main Authors: Laan, Danuel V., MD, Thiels, Cornelius A., DO, Glasgow, Amy, MHA, Wise, Kevin B., MD, Thompson, Geoffrey B., MD, Richards, Melanie L., MD, Farley, David R., MD, Truty, Mark J., MD, McKenzie, Travis J., MD
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Neoplasms - diagnostic imaging; Adrenal Cortex Neoplasms - mortality; Adrenal Cortex Neoplasms - pathology; Adrenal Cortex Neoplasms - surgery; Adrenalectomy - methods; Adrenocortical Carcinoma - diagnostic imaging; Adrenocortical Carcinoma - mortality; Adrenocortical Carcinoma - pathology; Adrenocortical Carcinoma - surgery; Adult; Aged; Cohort Studies; Disease-Free Survival; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Neoplastic Cells, Circulating - pathology; Prognosis; Retrospective Studies; Risk Assessment; Statistics, Nonparametric; Surgery; Survival Analysis; Thrombectomy; Treatment Outcome; Vena Cava, Inferior - pathology; Vena Cava, Inferior - surgery
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2016.07.040

Background The safety, efficacy, and prognostic implications of resection of adrenocortical carcinoma with inferior vena cava tumor thrombus are poorly described. Methods A retrospective review was performed during a 30-year period on patients who underwent resection of locally advanced, nonmetastatic adrenocortical carcinoma. We compared patients with and without inferior vena cava tumor thrombus, examining perioperative characteristics, completeness of resection, mortality, and survival. Results We identified 65 patients who underwent resection of locally advanced (T4N0 and T4N1) adrenocortical carcinoma (28 patients with inferior vena cava tumor thrombus, 37 noninferior vena cava tumor thrombus). Rate of complete resection, adjuvant chemotherapy, and short-term postoperative morbidity was similar between groups. Overall survival was similar at 12-months. At 24 months overall survival was less in the inferior vena cava tumor thrombus group (59% vs 30%, P  = .04). Differential survival through 60-month follow-up favored the noninferior vena cava tumor thrombus group (36% vs 0%, P  = .001). Subgroup analysis including only patients with complete resection demonstrates similar survival at 24-months but at 36-months survival favored the noninferior vena cava tumor thrombus patients (65% vs 29%, P  = .047) and this continued through 60 months (40% vs 0%, P  = .049). Conclusion Attempt at complete resection of adrenocortical carcinoma with inferior vena cava tumor thrombus seems justified particularly as short-term safety and survival are similar to patients without inferior vena cava tumor thrombus. However, survival beyond 36-months is limited in patients with inferior vena cava tumor thrombus. Patients being evaluated for resection in the setting of inferior vena cava tumor thrombus should be selected carefully.