6 research outputs found
Adrenocortical carcinoma: effect of hospital volume on patient outcome
PURPOSE: 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) ( 6510 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\u2009\ub1\u200954.6
vs 82.8\u2009\ub1\u200941.3\ua0mm; P\u2009<\u20090.001). A significantly higher rate of lymph node
dissection (P\u2009<\u20090.01) and of multiorgan resection (P\u2009<\u20090.01) was accomplished in
HVC. The number of patients who underwent adjuvant therapy was significantly
higher in HVC (P\u2009<\u20090.001). Local recurrence rate was lower in patients treated at
HVC (6% vs 18.5%; P\u2009=\u2009NS). Mean time to recurrence was significantly longer in
HVC than in LVC (25.2\u2009\ub1\u200928.1 vs 10.1\u2009\ub1\u20097.5; P\u2009<\u20090.01).
CONCLUSION: 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