title: Adrenocortical carcinoma: effect of hospital volume on patient outcome.
abstract: OBJECTIVE
  Optimal management of adrenocortical carcinoma (ACC) involves a detailed diagnostic workup, radical surgery, and appropriate adjuvant therapy. However, due to the rarity of this disease, adequate expertise is necessary to ensure optimal patient care. We evaluated if the experience of a treating center influences the outcome of ACC.
  
  
  METHODS
  Two hundred sixty-three patients who underwent adrenalectomy for ACC were included in a multi-institutional surgical survey and divided into 2 groups: "high-volume center" (HVC) (≥10 adrenalectomies for ACC) and "low-volume center" (LVC) (<10 adrenalectomies for ACC). A comparative analysis was performed.
  
  
  RESULTS
  One hundred seventy-two patients underwent adrenalectomy at HVC and 91 at LVC. The two groups were homogeneous for age, sex, clinical presentation, and stage. The mean lesions size of ACC was higher in HVC than in LVC (104.1 ± 54.6 vs 82.8 ± 41.3 mm; P < 0.001). A significantly higher rate of lymph node dissection (P < 0.01) and of multiorgan resection (P < 0.01) was accomplished in HVC. The number of patients who underwent adjuvant therapy was significantly higher in HVC (P < 0.001). Local recurrence rate was lower in patients treated at HVC (6% vs 18.5%; P = NS). Mean time to recurrence was significantly longer in HVC than in LVC (25.2 ± 28.1 vs 10.1 ± 7.5; P < 0.01).
  
  
  CONCLUSIONS
  The expertise of dedicated centers had a positive impact on the outcome of patients with ACC, resulting in a lower recurrence rate and improved mean time to recurrence. The improved patient outcome could be related not only to the appropriateness of the surgical procedure, but also to a more adequate multidisciplinary approach.
authors: Division of General and Endocrine Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
authors: Celestino Pio
authors: CP
authors: Lombardi
authors: Marco
authors: M
authors: Raffaelli
authors: Marco
authors: M
authors: Boniardi
authors: Giorgio
authors: G
authors: De Toma
authors: Luigi Antonio
authors: LA
authors: Marzano
authors: Paolo
authors: P
authors: Miccoli
authors: Francesco
authors: F
authors: Minni
authors: Mario
authors: M
authors: Morino
authors: Maria Rosa
authors: MR
authors: Pelizzo
authors: Andrea
authors: A
authors: Pietrabissa
authors: Andrea
authors: A
authors: Renda
authors: Andrea
authors: A
authors: Valeri
authors: Carmela
authors: C
authors: De Crea
authors: Rocco
authors: R
authors: Bellantone
mesh_terms: D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods / Q000706:statistics & numerical data*; D018268:Adrenocortical Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D011787:Quality of Health Care; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome; D016526:Workload / Q000706:statistics & numerical data*; D055815:Young Adult