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Commentary: Locoregional metastasis of adrenocortical carcinoma and lymphadenectomy – Disease clearance or identification of high-risk features?

Published:December 03, 2021DOI:https://doi.org/10.1016/j.amjsurg.2021.12.004
      Given the increased options for systemic treatment of adrenocortical carcinoma (ACC), attention has returned to focus on more effective control of the primary tumor and locoregional disease via development of best practices for surgical management. In ‘Informing Therapeutic Lymphadenectomy: Location of Regional Metastatic Lymph Nodes in Adrenocortical Carcinoma’,
      • Sada A.
      • Glasgow A.E.
      • Lyden M.L.
      • Dy B.M.
      • Foster T.R.
      • Habermann E.B.
      • Bancos I.
      • McKenzie T.J.
      Informing therapeutic lymphadenectomy: Location of regional metastatic lymph nodes in adrenocortical carcinoma.
      the authors document locoregional lymph node involvement by ACC from operations performed at a single institution over a 20 year period. While adding to the existing literature, we are reminded of the difficulty in examining this type of data. In addition to overall treatment heterogeneity affecting outcomes (both medical and surgical), the study results are dependent on lymph nodes being both resected by the surgeon and detected by pathology; thus, the true numerator and denominator for nodal involvement are likely different than reported. We must consider this in interpreting the results and making future treatment recommendations; however, the reader is provided with valuable information.
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