Observational studyEuropean journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology2025
A standardized surgical approach to multifocal locoregionally recurrent left-sided adrenocortical carcinoma.
Observational study in European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05237934 (Tissue Procurement and Natural History Study of Neuroendocrine Neoplasms), which is not on this map. Not yet cited in PubMed.
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The trial behind it
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Tissue Procurement and Natural History Study of Neuroendocrine Neoplasms (NENs) Including Adrenocortical Carcinoma (ACC)
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17 authors.
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Abstract
introductionSociety guidelines recommend surgery for recurrent adrenocortical carcinoma (ACC) in selected patients; however, no standards exist to guide surgeons, and this may be particularly problematic in the management of multifocal locoregional recurrence. MATERIALS AND
methodsA standardized approach was developed for patients with multifocal locoregionally recurrent left-sided ACC as part of an NCI study (NCT05237934). En bloc resection included the distal pancreas, spleen, left kidney, portion of left diaphragm, and possibly a portion of the left lateral liver, greater curve of the stomach, and/or descending colon. Morbidity, survival, and quality of life (QoL) were assessed.
resultsFrom 2018 to 2024, ten patients (median age 59 years) underwent multi-visceral en bloc resections for multifocal locoregionally recurrent left-sided ACC. Prior to surgery, 90 % of patients had undergone systemic therapy and a median of one prior operation (range 1-4). Size of local recurrence(s) averaged 6.5 cm (range 1.9-12.2 cm) at largest diameter, with a median of 3 (range 2-8) foci of disease identifiable on pre-operative imaging. Two patients (20 %) developed a Grade 1B post-operative pancreatic fistula. There were no peri-operative mortalities. Median locoregional recurrence-free survival was 22.1 months at 19.3 months of median follow-up. 50 % of QoL survey respondents reported feeling recovered/back to baseline activity level within 4 months of surgery.
conclusionLocoregional control can be obtained with reasonable success and acceptable morbidity in select patients with multifocal locoregionally recurrent left-sided ACC using a standardized left upper quadrant en bloc multi-visceral resection approach. Verification of the results of this technique is required in other experienced centers.
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