title: Lymphadenectomy for Adrenocortical Carcinoma: Is There a Therapeutic Benefit?
abstract: Lymph node metastasis is an established predictor of poor outcome for adrenocortical carcinoma (ACC); however, routine lymphadenectomy during surgical resection of ACC is not widely performed and its therapeutic role remains unclear.
  
  
  
  Patients undergoing margin-negative resection for localized ACC were identified from a multi-institutional database. Patients were stratified into 2 groups based on the surgeon's effort or not to perform a lymphadenectomy as documented in the operative note. Clinical, pathologic, and outcome data were compared between the 2 groups.
  
  
  
  Of 120 patients who met inclusion criteria from 1993 to 2014, 32 (27 %) underwent lymphadenectomy. Factors associated with lymphadenectomy were tumor size (12 vs. 9.5 cm; p = .007), palpable mass at presentation (26 vs. 12 %; p = .07), suspicious lymph nodes on preoperative imaging (44 vs. 7 %; p < .001), and need for multivisceral resection (78 vs. 36 %; p < .001). Median number of lymph nodes harvested was higher in the lymphadenectomy group (5.5 vs. 0; p < .001). In-hospital mortality (0 vs. 1.3 %; p = .72) and grade 3/4 complication rates (0 vs. 12 %; p = .061) were not significantly different. Patients who underwent lymphadenectomy had improved overall survival (5-year 76 vs. 59 %; p = .041). The benefit of lymphadenectomy on overall survival persisted on multivariate analysis (HR = 0.17; p = .006) controlling for adverse preoperative and intraoperative factors associated with lymphadenectomy, such as tumor size, palpable mass, irregular tumor edges, suspicious nodes on imaging, and multivisceral resection.
  
  
  
  In this multicenter study of adrenocortical carcinoma patients undergoing R0 resection, the surgeon's effort to dissect peritumoral lymph nodes was independently associated with improved overall survival.
authors: Department of Surgery, Stanford University, Stanford, CA, USA.
authors: Jon M
authors: JM
authors: Gerry
authors: Department of Surgery, Stanford University, Stanford, CA, USA.
authors: Thuy B
authors: TB
authors: Tran
authors: Department of Surgery, Emory University, Atlanta, GA, USA.
authors: Lauren M
authors: LM
authors: Postlewait
authors: Department of Surgery, Emory University, Atlanta, GA, USA.
authors: Shishir K
authors: SK
authors: Maithel
authors: Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA.
authors: Jason D
authors: JD
authors: Prescott
authors: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors: Tracy S
authors: TS
authors: Wang
authors: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors: Jason A
authors: JA
authors: Glenn
authors: Department of Surgery, The Ohio State University, Columbus, OH, USA.
authors: John E
authors: JE
authors: Phay
authors: Department of Surgery, The Ohio State University, Columbus, OH, USA.
authors: Kara
authors: K
authors: Keplinger
authors: Department of Surgery, Washington University, St. Louis, MO, USA.
authors: Ryan C
authors: RC
authors: Fields
authors: Department of Surgery, Washington University, St. Louis, MO, USA.
authors: Linda X
authors: LX
authors: Jin
authors: Department of Surgery, University of Wisconsin, Madison, WI, USA.
authors: Sharon M
authors: SM
authors: Weber
authors: Department of Surgery, University of Wisconsin, Madison, WI, USA.
authors: Ahmed
authors: A
authors: Salem
authors: Department of Surgery, University of California San Diego, San Diego, CA, USA.
authors: Jason K
authors: JK
authors: Sicklick
authors: Department of Surgery, University of California San Diego, San Diego, CA, USA.
authors: Shady
authors: S
authors: Gad
authors: Department of Surgery, University of Texas Southwestern, Dallas, TX, USA.
authors: Adam C
authors: AC
authors: Yopp
authors: Department of Surgery, University of Texas Southwestern, Dallas, TX, USA.
authors: John C
authors: JC
authors: Mansour
authors: Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
authors: Quan-Yang
authors: QY
authors: Duh
authors: Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
authors: Natalie
authors: N
authors: Seiser
authors: Department of Surgery, Vanderbilt University, Nashville, TN, USA.
authors: Carmen C
authors: CC
authors: Solorzano
authors: Department of Surgery, Vanderbilt University, Nashville, TN, USA.
authors: Colleen M
authors: CM
authors: Kiernan
authors: Department of Surgery, Wake Forest University, Winston Salem, NC, USA.
authors: Konstantinos I
authors: KI
authors: Votanopoulos
authors: Department of Surgery, Wake Forest University, Winston Salem, NC, USA.
authors: Edward A
authors: EA
authors: Levine
authors: Department of Surgery, New York University, New York, NY, USA.
authors: Ioannis
authors: I
authors: Hatzaras
authors: Department of Surgery, New York University, New York, NY, USA.
authors: Rivfka
authors: R
authors: Shenoy
authors: Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA.
authors: Timothy M
authors: TM
authors: Pawlik
authors: Department of Surgery, Stanford University, Stanford, CA, USA.
authors: Jeffrey A
authors: JA
authors: Norton
authors: Department of Surgery, Stanford University, Stanford, CA, USA. gpoultsides@stanford.edu.
authors: George A
authors: GA
authors: Poultsides
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000473:pathology* / Q000601:surgery; D000315:Adrenalectomy / Q000009:adverse effects; D018268:Adrenocortical Carcinoma / Q000556:secondary* / Q000601:surgery; D000328:Adult; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate; D047368:Tumor Burden