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

Published:October 19, 2021DOI:


      • 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.



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


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


      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.


      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.


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