Volume 122, Issue 6 pp. 1152-1162
RESEARCH ARTICLE

Critical analysis of lymph node examination in patients undergoing curative-intent resection for adrenocortical carcinoma

Benjamin W. Deschner MD

Benjamin W. Deschner MD

Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee

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Zachary E. Stiles DO

Zachary E. Stiles DO

Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee

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Olivia M. DeLozier MD

Olivia M. DeLozier MD

Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee

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Justin A. Drake MD

Justin A. Drake MD

Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee

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Miriam Tsao MD

Miriam Tsao MD

Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee

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Evan S. Glazer MD, PhD, FACS

Evan S. Glazer MD, PhD, FACS

Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee

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Jeremiah L. Deneve DO

Jeremiah L. Deneve DO

Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee

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Danny Yakoub MD, PhD

Danny Yakoub MD, PhD

Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee

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Paxton V. Dickson MD, FACS

Corresponding Author

Paxton V. Dickson MD, FACS

Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee

Correspondence Paxton V. Dickson, MD, FACS, 910 Madison Ave., Suite 301, Memphis, TN 38163.

Email: [email protected]

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First published: 23 July 2020
Citations: 7

Abstract

Background

Adrenocortical carcinoma (ACC) is a rare tumor and the role of lymph node dissection remains ill-defined. This study evaluates the effect of nodal examination on prognosis and survival in patients undergoing curative-intent resection of ACC.

Methods

The National Cancer Database (2004-2015) was queried for patients undergoing margin-negative resection for ACC. Patients with distant metastases, neoadjuvant therapy, multivisceral resection and T4 tumors were excluded.

Results

Among 897 patients, 147 (16.4%) had lymph nodes examined. Factors associated with lymph node examination included increasing tumor size (P < .001), extra-adrenal extension (P < .001), open operation (P < .001), and resection at an academic facility (P = .003). Lymph node metastasis was significantly associated with extra-adrenal tumor extension (P = .04). Lymph node harvest, regardless of the number of nodes examined, was not associated with a survival benefit. Median overall survival was incrementally worse with increasing number of positive lymph nodes (88.2 months for N0, 34.9 months for 1-3 positive nodes, and 15.6 months for ≥4 positive nodes, P < .001).

Conclusions

Lymph node harvest and lymph node metastasis were associated with more advanced tumors. Although nodal harvest did not offer a survival advantage, stratifying the nodal staging classification may provide important prognostic information.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author upon reasonable request.

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