Results of surgical treatment of adrenocortical cancer

BACKGROUND: Adrenalectomy is the only possible method of radical treatment of adrenocortical cancer, and surgical approach (laparotomy or laparoscopy) remains a subject of debate.

AIM: To evaluate one-year mortality in patients with adrenocortical cancer and determine its relationship with age, stage of the disease, tumor characteristics according to computed tomography results, and surgical approach.

MATERIAL AND METHODS: In the Perm Regional Clinical Hospital, over the past 7 years, 107 patients have been operated on for adrenal tumors, of which 15 (14.01%) people were diagnosed with adrenocortical cancer. Adrenalectomy was performed by open (11) and laparoscopic (4) approaches. The results were assessed by the number of local relapses of the disease and life expectancy. Statistical analysis was carried out using standard application programs Statistica for Windows 10.0. Nonparametric methods of descriptive statistics were used. To determine the relationship between individual pairs of characteristics and the degree of its severity, the Spearman correlation coefficient (r) was calculated.

RESULTS: Stage I of the disease according to the ENSAT classification was found in 1 case, II — in 7, III — in 5, IV — in 2 cases. The size of tumors removed laparoscopically was significantly smaller (p=0.042) compared to those operated on with an open approach. One-year survival rate was 80%. Surgical approach and combined operations did not affect one-year mortality (r=0.277; p=0.298 and r=–0.462; p=0.071). A relationship was found between lethal outcomes and age (r=–0.539; p=0.030), and the rate of washout of the contrast agent from the tumor in the delayed phase when performing computed tomography (r=–0.845; p=0.034). In case of lethal outcomes, the rate of washout of the contrast agent was the lowest. The life expectancy of patients depended on the stage of the disease (r=–0.590; p=0.016).

CONCLUSION: One-year mortality in patients with adrenocortical cancer was 20% and had a moderate positive correlation with age, stage of the disease and a strong correlation with tumor characteristics based on bolus-enhanced computed tomography, but had no relationship with the chosen surgical approach.