Journal Article

Incidence of Perioperative Complications Following Resection of Adrenocortical Carcinoma and Its Association with Long-Term Survival

Pawlik, Timothy M., Salem, Ahmed, Duh, Quan-Yang, Shenoy, Rivfka, Tran, Thuy B., Evans, Douglas B., Solorzano, Carmen C., Weber, Sharon M., Poultsides, George A., Hatzaras, Ioannis, Phay, John E., Mansour, John C., Sicklick, Jason K., Margonis, Georgios Antonios, Levine, Edward A., Seiser, Natalie, Gad, Shady, Fields, Ryan C., Amini, Neda, Kiernan, Colleen M., Kim, Yuhree, Keplinger, Kara, Maithel, Shishir K., Wang, Tracy S., Yopp, Adam C., Postlewait, Lauren M., Moses, Lindsey E., Votanopoulos, Konstantinos I.

2016

Overview

Background The association of postoperative complications with long-term oncologic outcomes remains unclear. We sought to determine the incidence of complications among patients who underwent surgery for adrenocortical carcinoma (ACC) and define the relationship of morbidity with long-term survival. Methods Patients who underwent surgery for ACC between 1993 and 2014 were identified from 13 academic institutions participating in the US ACC group study. The incidence and type of the postoperative complications, the factors associated with them as well their association with long-term survival were analyzed. Results A total of 265 patients with median age of 52 years (IQR 44–63) were identified; at surgery, the majority of patients underwent an open abdominal procedure ( n  = 169, 66.8 %). A postoperative complication occurred in 99 patients for a morbidity of 37.4 %; five patients (1.9 %) died in hospital. Factors associated with morbidity included a thoraco-abdominal operative approach (reference: open abdominal; OR 2.85, 95 % CI 1.00–8.18), and a hormonally functional tumor (OR 3.56, 95 % CI 1.65–7.69) (all P  < 0.05). Presence of any complication was associated with a worse long-term outcome (median survival: no complication, 58.9 months vs. any complication, 25.1 months; P  = 0.009). In multivariate analysis, after adjusting for patient- and disease-related factors postoperative infectious complications independently predicted shorter overall survival (hazard ratio (HR) 5.56, 95 % CI 2.24–13.80; P  < 0.001). Conclusion Postoperative complications were independently associated with decreased long-term survival after resection for ACC. The prevention of complications may be important from an oncologic perspective.

• Publisher: Springer International Publishing,John Wiley & Sons, Inc
• Subject: Abdominal Surgery / Adrenal Cortex Neoplasms - mortality / Adrenal Cortex Neoplasms - surgery / Adrenalectomy - adverse effects / Adrenalectomy - mortality / Adrenocortical Carcinoma / Adrenocortical Carcinoma - mortality / Adrenocortical Carcinoma - surgery / Adult / Cardiac Surgery / Clostridium Difficile Infection / Female / Forecasting / General Surgery / Humans / Infectious Complication / Male / Medicine / Medicine & Public Health / Middle Aged / Morbidity - trends / National Surgical Quality Improvement Program / Original Scientific Report / Postoperative Complication / Postoperative Complications - epidemiology / Proportional Hazards Models / Surgery / Thoracic Surgery / United States - epidemiology / Vascular Surgery