Laparoscopic surgery for adrenocortical carcinoma: Estimating the risk of margin-positive resection.

Autor: Carlisle K; Division of General and Oncologic Surgery, Department of Surgery, University of Maryland Baltimore, Baltimore, Maryland, USA., Blackburn KW; Division of General and Oncologic Surgery, Department of Surgery, University of Maryland Baltimore, Baltimore, Maryland, USA., Japp EA; Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA., McArdle PF; Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Maryland Surgery, Pharmacy, and Anesthesiology Research Collaborative, Baltimore, Maryland, USA., Turner DJ; Division of General and Oncologic Surgery, Department of Surgery, University of Maryland Baltimore, Baltimore, Maryland, USA., Terhune JH; Division of General and Oncologic Surgery, Department of Surgery, University of Maryland Baltimore, Baltimore, Maryland, USA., Englum BR; Division of General and Oncologic Surgery, Department of Surgery, University of Maryland Baltimore, Baltimore, Maryland, USA.; Maryland Surgery, Pharmacy, and Anesthesiology Research Collaborative, Baltimore, Maryland, USA., Smith PW; Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA., Hu Y; Division of General and Oncologic Surgery, Department of Surgery, University of Maryland Baltimore, Baltimore, Maryland, USA.; Maryland Surgery, Pharmacy, and Anesthesiology Research Collaborative, Baltimore, Maryland, USA.
Jazyk: angličtina
Zdroj: Journal of surgical oncology [J Surg Oncol] 2024 Mar; Vol. 129 (4), pp. 691-699. Date of Electronic Publication: 2023 Nov 30.
DOI: 10.1002/jso.27544
Abstrakt: Background: Over recent years, there has been increasing adoption of minimally invasive surgery (MIS) in the treatment of adrenocortical carcinoma (ACC). However, MIS has been associated with noncurative resection and locoregional recurrence. We aimed to identify risk factors for margin-positivity among patients who undergo MIS resection for ACC. We hypothesized that a simple nomogram can accurately identify patients most suitable for curative MIS resection.
Methods: Curative-intent resections for ACC were identified through the National Cancer Database spanning 2010-2018. Trends in MIS utilization were reported using Pearson correlation coefficients. Factors associated with margin-positive resection were identified among preoperatively available variables using multivariable logistic regression, then incorporated into a predictive model. Model quality was cross validated using an 80% training data set and 20% test data set.
Results: Among 1260 ACC cases, 38.6% (486) underwent MIS resection. MIS utilization increased over time at nonacademic centers (R = 0.818, p = 0.007), but not at academic centers (R = 0.009, p = 0.982). Factors associated with margin-positive MIS resection were increasing age, nonacademic center (odds ratio [OR]: 1.8, p = 0.006), cT3 (OR: 4.7, p < 0.001) or cT4 tumors (OR: 14.6, p < 0.001), and right-sided tumors (OR: 2.0, p = 0.006). A predictive model incorporating these four factors produced favorable c-statistics of 0.75 in the training data set and 0.72 in the test data set. A pragmatic nomogram was created to enable bedside risk stratification.
Conclusions: An increasing proportion of ACC are resected via minimally invasive operations, particularly at nonacademic centers. Patient selection based on a few key factors can minimize the risk of noncurative surgery.
(© 2023 Wiley Periodicals LLC.)
Databáze: MEDLINE
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