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Informing therapeutic lymphadenectomy: Location of regional metastatic lymph nodes in adrenocortical carcinoma

Published:October 19, 2021DOI:https://doi.org/10.1016/j.amjsurg.2021.10.014

      Highlights

      • The most common sites for lymph node (LN) metastases in right ACC are para-caval LN.
      • The most common sites for LN metastases in left ACC are para-aortic and renal-hilar LN.
      • Further studies are needed to define the boundaries of therapeutic lymphadenectomy.

      Abstract

      Background

      The anatomic boundaries of lymphadenectomy for adrenocortical carcinoma (ACC) are not defined.

      Methods

      Adults undergoing resection of ACC were included. Locations were categorized based on positive LN locations on final pathology.

      Results

      Of 231 resected ACC, 6% had positive LN during initial resection. Positive LN in left ACC (n = 7) were: 2 para-aortic, 2 left renal-hilar, 1 para-aortic and left renal-hilar and 1 unknown, while for right ACC (n = 7): 2 para-caval, 1 para-caval and right renal-hilar, 1 inter-aortocaval, 1 celiac, 1 para-aortic, and 1 unknown. Of 55 resections for recurrent ACC, positive LN in left ACC (n = 2) were: 1 para-aortic, and 1 para-aortic with left renal-hilar, while LN for right ACC (n = 7): 2 inter-aortocaval, 2 right renal-hilar, 2 para-caval and one retrocrural.

      Conclusion

      The most common LN metastases are para-caval for right, and para-aortic and left renal-hilar for left ACC. Further studies are necessary to determine the boundaries of lymphadenectomy in ACC resection.

      Keywords

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      References

        • Sada A.
        • Asaad M.
        • Bews K.A.
        • et al.
        Comparison between functional and non-functional adrenocortical carcinoma.
        Surgery. 2020; 167: 216-223
        • Gerry J.M.
        • Tran T.B.
        • Postlewait L.M.
        • et al.
        Lymphadenectomy for adrenocortical carcinoma: is there a therapeutic benefit?.
        Ann Surg Oncol. 2016; 23: 708-713
        • Miller B.S.
        • Doherty G.M.
        Surgical management of adrenocortical tumours.
        Nat Rev Endocrinol. 2014 May; 10 (PubMed PMID: 24637859. Epub 2014/03/19): 282-292
        • Sada A.
        • Glasgow A.E.
        • Lyden M.L.
        • et al.
        Positive lymph nodes in adrenocortical carcinoma: what does it mean?.
        World J Surg. 2021; 45: 188-194
        • Dickson P.V.
        • Kim L.
        • Yen T.W.F.
        • et al.
        Evaluation, staging, and surgical management for adrenocortical carcinoma: an update from the SSO endocrine and head and neck disease site working group.
        Ann Surg Oncol. 2018 Nov; 25 (PubMed PMID: 30229419. Epub 2018/09/20): 3460-3468
        • Reibetanz J.
        • Jurowich C.
        • Erdogan I.
        • et al.
        Impact of lymphadenectomy on the oncologic outcome of patients with adrenocortical carcinoma.
        Ann Surg. 2012 Feb; 255 (PubMed PMID: 22143204. Epub 2011/12/07): 363-369
        • Reibetanz J.
        • Rinn B.
        • Kunz A.S.
        • et al.
        Patterns of lymph node recurrence in adrenocortical carcinoma: possible implications for primary surgical treatment.
        Ann Surg Oncol. 2019 Feb; 26 (PubMed PMID: 30443830. Epub 2018/11/18): 531-538
        • Gaujoux S.
        • Mihai R.
        Joint working group of E, Ensat. European Society of Endocrine Surgeons (ESES) and European Network for the Study of Adrenal Tumours (ENSAT) recommendations for the surgical management of adrenocortical carcinoma.
        Br J Surg. 2017 Mar; 104 (PubMed PMID: 28199015. Epub 2017/02/16): 358-376
        • Gaujoux S.
        • Brennan M.F.
        Recommendation for standardized surgical management of primary adrenocortical carcinoma.
        Surgery. 2012 Jul; 152 (PubMed PMID: 22306837. Epub 2012/02/07): 123-132