Comparative Experience of Surgical Management of Patients with Adrenocortical Cancers and Retroperitoneal Sarcomas

Thwin M, Sia Y, Darby C, Srikanth R, Mihai R

Department of Endocrine Surgery, Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, UK Department of Vascular Surgery, Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, UK Department of Hepatobiliary Surgery, Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, UK

^*Correspondance to: Radu Mihai 

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Abstract:

Background: Adrenocortical Carcinomas (ACC) and Retroperitoneal Sarcomas (RPS) are very rare tumors for whom radical surgical resection remains the mainstay of treatment. This study compares the surgical management and outcomes of such patients operated in a single institution. Methods: Retrospective cohort study of patients who underwent definitive surgical management for ACC and RPS over a decade. Results: Between 2012-2022, 44 patients (19M:25F, mean age 54 years) had adrenalectomy for ACC and 44 patients (16M:28F, mean age 58 years) had resection of retroperitoneal tumors, of whom 29 patients had histologically-confirmed RPS and 15 patients had benign tumors. Multiorgan resection was performed in 24 ACC and 22 RPS and involvement of multiple surgical specialties (hepatobiliary/vascular/cardiac surgery) was necessary in 3 ACC cases and 13 RPS cases. Only 16 of 88 patients were admitted to ITU postoperatively and median length of hospital admission was 6 days (range 1-36). There was one in-hospital death in each group. When ipsilateral nephrectomy was performed, eGFR dropped at 6 to 12 months postop from 77 ± 20 (pre-op) to 64 ± 19 ml/min/1.73m2 in patients with ACC and from 88 ± 4 (pre-op) to 70 ± 22 ml/min/1.73m2 in patients with RPS. No change in eGFR was observed in either group when nephrectomy was omitted. Overall survival was better in the RPS group compared with ACC (76 ± 10 vs. 64 ± 9 months). Conclusion: Surgery for ACC and RPS poses similar challenges. The combination of surgical practice for both types of tumors is beneficial and can facilitate growing confidence in a multidisciplinary approach for these rare and complex cases.

Keywords:

Adrenocortical Cancers; Retroperitoneal Sarcomas; ESES

Cite the Article:

Thwin M, Sia Y, Darby C, Srikanth R, Mihai R. Comparative Experience of Surgical Management of Patients with Adrenocortical Cancers and Retroperitoneal Sarcomas. World J Surg Surgical Res. 2023; 6: 1512..