Araştırma Makalesi
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Adrenocortıc Carcınoma, Sıngle Center 5 Years Experıence

Yıl 2021, Cilt 2, Sayı 3, 190 - 193, 17.11.2021

Öz

Introduction: Adrenocortical cancer (ACC) is a rare cancer. Surgical resection is the only known curative treatment for ACC. Recurrence rates of up to 70% have been reported after surgical treatment. Surgical margin positivity was defined as poor prognostic factor. Therefore, it is recommended that ACC surgery be performed by experienced surgeons in high-volume centers. The aim of our study is to share our surgical experience in this rare disease group. Methods: The data of 8 patients who underwent adrenalectomy for ACC between March 2016 and March 2021 in the General Surgery Clinic of Osmangazi University were retrospectively analyzed. Results: Five of the patients were female and 3 were male. Three (37.5%) of the ACCs were located in the right adrenal gland, and 5 (62.5%) were located in the left adrenal gland. Biochemical examinations revealed functional tumors in 5 patients. The mean age of our patients was 45 (25-72). Five (62.5%) of the patients were operated with open surgery method and 3 (37.5%) patients were operated with laparoscopic transabdominal approach. Invasion to the left kidney and spleen was observed in 2 patients diagnosed at locally advanced stage. These patients underwent en-bloc resections with nephrectomy and splenectomy in addition to adrenalectomy. No complications were observed in any of the patients in the perioperative and early postoperative period. Conclusion: ACC is a rare tumor. Experience is limited in most centres. The efficacy and results of surgical treatment in ACC can be better analyzed with multicenter and prospective studies.

Kaynakça

  • 1. Xiao XR, Ye LY, Shi LX, Cheng GF, Li YT, Zhou BM. Diagnosis and treatment of adrenal tumours: a review of 35 years' experience. Br J Urol. 1998;82(2):199-205.
  • 2. Luton JP, Cerdas S, Billaud L, et al. Clinical features of adrenocortical carcinoma, prognostic factors, and the effect of mitotane therapy. N Engl J Med. 1990;322(17):1195-201.
  • 3. Fassnacht M, Dekkers OM, Else T, et al. European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2018;179(4):G1-G46.
  • 4. Harrison LE, Gaudin PB, Brennan MF. Pathologic features of prognostic significance for adrenocortical carcinoma after curative resection. Arch Surg. 1999;134(2):181-5.
  • 5. Reibetanz J, Jurowich C, Erdogan I, ey al. Impact of lymphadenectomy on the oncologic outcome of patients with adrenocortical carcinoma. Ann Surg. 2012;255(2):363-9.
  • 6. Bilimoria KY, Shen WT, Elaraj D, Bentrem DJ, Winchester DJ, Kebebew E, Sturgeon C. Adrenocortical carcinoma in the United States: treatment utilization and prognostic factors. Cancer. 2008;113(11):3130-6.
  • 7. Schulick RD, Brennan MF. Long-term survival after complete resection and repeat resection in patients with adrenocortical carcinoma. Ann Surg Oncol. 1999;6(8):719-26.
  • 8. Kebebew E, Reiff E, Duh QY, Clark OH, McMillan A. Extent of disease at presentation and outcome for adrenocortical carcinoma: have we made progress? World J Surg. 2006;30(5):872-8.
  • 9. Ng L, Libertino JM. Adrenocortical carcinoma: diagnosis, evaluation and treatment. J Urol. 2003;169(1):5-11.
  • 10. Allolio B, Fassnacht M. Clinical review: Adrenocortical carcinoma: clinical update. J Clin Endocrinol Metab. 2006 Jun;91(6):2027-37.
  • 11. Weiss LM, Medeiros LJ, Vickery AL Jr. Pathologic features of prognostic significance in adrenocortical carcinoma. Am J Surg Pathol. 1989;13(3):202-6.
  • 12. Abiven G, Coste J, Groussin L, Anract P, Tissier F, Legmann P, Dousset B, Bertagna X, Bertherat J. Clinical and biological features in the prognosis of adrenocortical cancer: poor outcome of cortisol-secreting tumors in a series of 202 consecutive patients. J Clin Endocrinol Metab. 2006;91(7):2650-5.
  • 13. Paton BL, Novitsky YW, Zerey M, Harrell AG, Norton HJ, Asbun H, Kercher KW, Heniford BT. Outcomes of adrenal cortical carcinoma in the United States. Surgery. 2006;140(6):914-20; discussion 919-20.
  • 14. Efficacy of Adjuvant Mitotane Treatment (ADIUVO). U.S National Library of Medicine. May, 8, 2017. Available at:https://clinicaltrials.gov/ct2/show/NCT00777244

Adrenokortikal Karsinom, Tek Merkez 5 Yıllık Deneyim

Yıl 2021, Cilt 2, Sayı 3, 190 - 193, 17.11.2021

Öz

Giriş: Adrenokortikal kanser (AKK) nadir görülen bir kanser türüdür. Cerrahi rezeksiyon, AKK için bilinen tek küratif tedavi yöntemidir. Cerrahi tedavi sonrası %70’ e varan nüks oranları bildirilmiştir. Cerrahi sınır pozitifliği ve tümörün ekimi kötü prognostik faktörlerdir. Bu nedenle AKK cerrahisinin yüksek volümlü merkezlerde deneyimli cerrahlar tarafından yapılması önerilmektedir. Çalışmamızın amacı, nadir görülen bu hastalık grubundaki cerrahi deneyimimizi paylaşmaktır. Yöntemler: Osmangazi Üniversitesi Genel Cerrahi Kliniğinde Mart 2016-Mart 2021 tarihleri arasında AKK nedeniyle adrenalektomi uygulanan 8 hastanın verileri retrospektif olarak incelendi. Bulgular: Çalışmaya dahil edilen toplam 8 hastanın 5’ i kadın 3’ ü erkekti. AKK’ lerin 3’ ü (%37,5) sağ, 5’i (%62,5) sol adrenal bezde yerleşimli idi. Biyokimyasal incelemelerde 5 hastada (%62,5) fonksiyonel tümör saptandı. Hastalarımızın ortalama yaşı 45 (25-72) idi. Hastaların 5’ i (%62,5) açık cerrahi yöntemle 3’ ü (%37,5) ise laparoskopik yöntemle, transabdominal teknikle opere edildi. Lokal ileri evrede tanı alan 2 hastada sol böbreğe ve dalağa invazyon görüldü. Bu hastalara adrenalektomiye ek olarak nefrektomi ve splenektominin eklendiği en-blok rezeksiyonlar uygulandı. Perioperatif ve erken postoperatif dönemde hastaların hiçbirinde komplikasyon izlenmedi. Sonuç: AKK nadir görülen bir tümördür. Çoğu merkezde deneyim kısıtlıdır. Çok merkezli ve prospektif olarak dizayn edilecek çalışmalarla AKK’ de cerrahi tedavinin etkinliği ve sonuçları daha iyi şekilde analiz edilebilir.

Kaynakça

  • 1. Xiao XR, Ye LY, Shi LX, Cheng GF, Li YT, Zhou BM. Diagnosis and treatment of adrenal tumours: a review of 35 years' experience. Br J Urol. 1998;82(2):199-205.
  • 2. Luton JP, Cerdas S, Billaud L, et al. Clinical features of adrenocortical carcinoma, prognostic factors, and the effect of mitotane therapy. N Engl J Med. 1990;322(17):1195-201.
  • 3. Fassnacht M, Dekkers OM, Else T, et al. European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2018;179(4):G1-G46.
  • 4. Harrison LE, Gaudin PB, Brennan MF. Pathologic features of prognostic significance for adrenocortical carcinoma after curative resection. Arch Surg. 1999;134(2):181-5.
  • 5. Reibetanz J, Jurowich C, Erdogan I, ey al. Impact of lymphadenectomy on the oncologic outcome of patients with adrenocortical carcinoma. Ann Surg. 2012;255(2):363-9.
  • 6. Bilimoria KY, Shen WT, Elaraj D, Bentrem DJ, Winchester DJ, Kebebew E, Sturgeon C. Adrenocortical carcinoma in the United States: treatment utilization and prognostic factors. Cancer. 2008;113(11):3130-6.
  • 7. Schulick RD, Brennan MF. Long-term survival after complete resection and repeat resection in patients with adrenocortical carcinoma. Ann Surg Oncol. 1999;6(8):719-26.
  • 8. Kebebew E, Reiff E, Duh QY, Clark OH, McMillan A. Extent of disease at presentation and outcome for adrenocortical carcinoma: have we made progress? World J Surg. 2006;30(5):872-8.
  • 9. Ng L, Libertino JM. Adrenocortical carcinoma: diagnosis, evaluation and treatment. J Urol. 2003;169(1):5-11.
  • 10. Allolio B, Fassnacht M. Clinical review: Adrenocortical carcinoma: clinical update. J Clin Endocrinol Metab. 2006 Jun;91(6):2027-37.
  • 11. Weiss LM, Medeiros LJ, Vickery AL Jr. Pathologic features of prognostic significance in adrenocortical carcinoma. Am J Surg Pathol. 1989;13(3):202-6.
  • 12. Abiven G, Coste J, Groussin L, Anract P, Tissier F, Legmann P, Dousset B, Bertagna X, Bertherat J. Clinical and biological features in the prognosis of adrenocortical cancer: poor outcome of cortisol-secreting tumors in a series of 202 consecutive patients. J Clin Endocrinol Metab. 2006;91(7):2650-5.
  • 13. Paton BL, Novitsky YW, Zerey M, Harrell AG, Norton HJ, Asbun H, Kercher KW, Heniford BT. Outcomes of adrenal cortical carcinoma in the United States. Surgery. 2006;140(6):914-20; discussion 919-20.
  • 14. Efficacy of Adjuvant Mitotane Treatment (ADIUVO). U.S National Library of Medicine. May, 8, 2017. Available at:https://clinicaltrials.gov/ct2/show/NCT00777244

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Bilimleri ve Hizmetleri
Bölüm Araştırma Makaleleri
Yazarlar

Hayrettin DİZEN
Osmangazi Üniversitesi Tıp Fakültesi
0000-0002-4031-2557
Türkiye


Dursun Burak ÖZDEMİR (Sorumlu Yazar)
ESOGU
0000-0002-3672-5738
Türkiye


Ahmet KARAYİĞİT
Osmangazi Üniversitesi Tıp Fakültesi
0000-0003-0380-9190
Türkiye


Bülent ÜNAL
Osmangazi Üniversitesi Tıp Fakültesi
0000-0003-2538-7961
Türkiye

Yayımlanma Tarihi 17 Kasım 2021
Yayınlandığı Sayı Yıl 2021, Cilt 2, Sayı 3

Kaynak Göster

Vancouver Dizen H. , Özdemir D. B. , Karayiğit A. , Ünal B. Adrenokortikal Karsinom, Tek Merkez 5 Yıllık Deneyim. Eskisehir Medical Journal. 2021; 2(3): 190-193.