Procopio Priscilla Francesca, Pennestrì Francesco, Laurino Antonio, Rossi Esther Diana, Schinzari Giovanni, Pontecorvi Alfredo, De Crea Carmela, Raffaelli Marco
U.O.C. Chirurgia Endocrina E Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Centro Di Ricerca in Chirurgia Delle Ghiandole Endocrine E Obesità, Università Cattolica del Sacro Cuore, Rome, Italy.
Updates Surg. 2025 May 3. doi: 10.1007/s13304-025-02215-z.
In locally advanced adrenocortical carcinoma (ACC) (ENSAT stage III - S-III) R0 surgery, involving en bloc extended resections, is the only potential curative treatment. We evaluated oncological outcomes and complications rate in S-III patients who underwent extended resection in comparison with stage I/II (S-I/II). Among 1098 adrenalectomies over 27 years (1997 -2024) in a tertiary referral center, medical records of ACC patients were reviewed, excluding stage IV and not-multivisceral resections in S-III patients. Forty-eight patients met the inclusion criteria: 6 S-I (12.5%), 36 S-II (75%) and 6 S-III (12.5%) patients. The latter patients' cohort underwent multivisceral en bloc resections (3 total nephrectomies, one renal vein thrombectomy, one splenopancreasectomy associated with total nephrectomy, left hemicolectomy and omentectomy, one liver S6-S7-S8 resection). Open adrenalectomy was scheduled in all S-III patients. Minimally-invasive approach was scheduled in 21 (50%) S-I/II patients. Conversion to open adrenalectomy was registered in 5 out these 21 patients. Locoregional and distant disease recurrences were registered in 19% of S-I/II vs 33.3% of S-III patients and 28.6% of S-I/II vs 66.7% of S-III patients, respectively (p = 0.420, p = 0.064). Postoperative complications were observed in 21.4% of S-I/II patients and 16.7% of S-III patients (p = 0.788). Kaplan-Meier DFS and OS curves were comparable among the two groups (p = 0.255, p = 0.459, respectively). After univariable analysis, hyperfunction and chemotherapy were significantly associated with locoregional disease recurrence (p = 0.02, p = 0.04, respectively). OS and DFS of S-III ACC patients undergoing extended en bloc R0 resections were comparable to those of S-I/II patients, without increased postoperative morbidity.
在局部晚期肾上腺皮质癌（ACC）（欧洲肾上腺肿瘤研究网络（ENSAT）III期 - S-III期）中，R0手术（包括整块扩大切除术）是唯一可能的治愈性治疗方法。我们评估了接受扩大切除术的S-III期患者与I/II期（S-I/II期）患者的肿瘤学结局和并发症发生率。在一家三级转诊中心27年（1997 - 2024年）期间进行的1098例肾上腺切除术中，对ACC患者的病历进行了回顾，排除IV期患者以及S-III期患者中未进行多脏器切除术的病例。48例患者符合纳入标准：6例S-I期（12.5%）、36例S-II期（75%）和6例S-III期（12.5%）患者。后一组患者接受了多脏器整块切除术（3例全肾切除术、1例肾静脉血栓切除术、1例与全肾切除术相关的脾胰切除术、左半结肠切除术和大网膜切除术、1例肝S6 - S7 - S8段切除术）。所有S-III期患者均计划进行开放性肾上腺切除术。21例（50%）S-I/II期患者计划采用微创方法。这21例患者中有5例转为开放性肾上腺切除术。S-I/II期患者局部和远处疾病复发率分别为19%和33.3%，S-I/II期患者和S-III期患者分别为28.6%和66.7%（p = 0.420，p = 0.064）。S-I/II期患者术后并发症发生率为21.4%，S-III期患者为16.7%（p = 0.788）。两组的Kaplan-Meier无病生存期（DFS）和总生存期（OS）曲线具有可比性（分别为p = 0.255，p = 0.459）。单因素分析后，功能亢进和化疗与局部疾病复发显著相关（分别为p = 0.02，p = 0.04）。接受扩大整块R0切除术的S-III期ACC患者的OS和DFS与S-I/II期患者相当，且术后发病率没有增加。
