Adrenocortical carcinoma: effect of hospital volume on patient outcome.
Langenbecks Arch Surg
; 397(2): 201-7, 2012 Feb.
Article
em En
| MEDLINE
| ID: mdl-22069043
ABSTRACT
PURPOSE:
Optimal management of adrenocortical carcinoma (ACC) involves a detailed diagnostic workup, radical surgery, and appropriate adjuvant therapy. However, due to the rarity of this disease, adequate expertise is necessary to ensure optimal patient care. We evaluated if the experience of a treating center influences the outcome of ACC.METHODS:
Two hundred sixty-three patients who underwent adrenalectomy for ACC were included in a multi-institutional surgical survey and divided into 2 groups "high-volume center" (HVC) (≥10 adrenalectomies for ACC) and "low-volume center" (LVC) (<10 adrenalectomies for ACC). A comparative analysis was performed.RESULTS:
One hundred seventy-two patients underwent adrenalectomy at HVC and 91 at LVC. The two groups were homogeneous for age, sex, clinical presentation, and stage. The mean lesions size of ACC was higher in HVC than in LVC (104.1 ± 54.6 vs 82.8 ± 41.3 mm; P < 0.001). A significantly higher rate of lymph node dissection (P < 0.01) and of multiorgan resection (P < 0.01) was accomplished in HVC. The number of patients who underwent adjuvant therapy was significantly higher in HVC (P < 0.001). Local recurrence rate was lower in patients treated at HVC (6% vs 18.5%; P = NS). Mean time to recurrence was significantly longer in HVC than in LVC (25.2 ± 28.1 vs 10.1 ± 7.5; P < 0.01).CONCLUSION:
The expertise of dedicated centers had a positive impact on the outcome of patients with ACC, resulting in a lower recurrence rate and improved mean time to recurrence. The improved patient outcome could be related not only to the appropriateness of the surgical procedure, but also to a more adequate multidisciplinary approach.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Carga de Trabalho
/
Neoplasias do Córtex Suprarrenal
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Carcinoma Adrenocortical
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Adrenalectomia
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Hospitais
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Recidiva Local de Neoplasia
Tipo de estudo:
Clinical_trials
/
Evaluation_studies
/
Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adolescent
/
Adult
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Aged
/
Aged80
/
Child
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Female
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Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Langenbecks Arch Surg
Ano de publicação:
2012
Tipo de documento:
Article
País de afiliação:
Itália