What is the clinical evidence from this study?

Study design: Observational. Population: Adrenocortical carcinoma with intracaval extension of tumor thrombus (n=29). Intervention: Surgical extirpation with cardiac bypass techniques. Primary outcome: Intraoperative mortality and residual disease.

What question did this study set out to answer?

To characterize the clinical presentation, operative management, and prognostic outcomes of adrenocortical carcinoma presenting with tumor thrombus extension into the vena cava.

December 1, 1997The Journal of Urology

Adrenocortical Carcinoma With Intracaval Extension

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Key result

In 29 patients with adrenocortical carcinoma and intracaval extension, cardiac bypass techniques were used in 14 patients with no intraoperative mortalities, supporting complete surgical extirpation.

Population

29 patients aged 6 to 77 years with adrenocortical carcinoma and intracaval extension of tumor thrombus.

Design

Case_series

Authors

SHSean P. HedicanUniversity of Iowa FMFray F. MarshallNorthwestern University

Discussion

Member takes

Implication

May support bypass-assisted resection in select cases; hypothesis-generating from Level 5 data and should not change practice.

Key Points

To characterize the clinical presentation, operative management, and prognostic outcomes of adrenocortical carcinoma presenting with tumor thrombus extension into the vena cava.
Retrospective review of 29 total cases of adrenocortical carcinoma with cavoatrial tumor thrombus, comprising 3 institutional patients and 26 cases identified in medical literature from 1972 to 1997.
Evaluated patient demographics, clinical symptoms, primary tumor size and laterality, cephalad thrombus extent, surgical use of cardiopulmonary bypass, and adjuvant mitotane therapy.
Patients had a mean age of 41.3 years (range 6 to 77), 79% (23/29) were female, 83% (24/29) of tumors arose in the right adrenal gland, and mean tumor diameter was 10.1 cm.
Thrombus propagated to the right atrium in 15 patients, retrohepatic vena cava in 7, and subhepatic vena cava in 7; 76% presented with abnormal steroid metabolism.
Cardiopulmonary bypass was used in 14 resections with zero intraoperative deaths, whereas 3 intraoperative mortalities occurred in non-bypass procedures, and 6 of 8 patients receiving postoperative mitotane achieved disease-free status.

Study Design

Type

Observational (n=29)

Multicenter

Yes

Structured PICO

Population

29 patients (23 female, 6 male) aged 6 to 77 years with adrenocortical carcinoma and intracaval extension of tumor thrombus.

Exposure

Surgical extirpation (with or without cardiac bypass techniques) and postoperative mitotane.

Outcome

Presentation, management, and outcome (including intraoperative mortality and survival).hard clinical

Complete surgical extirpation using cardiac bypass techniques appears to be the safest approach for adrenocortical carcinoma with intracaval extension, avoiding intraoperative mortality.

Cite This Study

Hedican et al. (1997) conducted an observational in Adrenocortical carcinoma with intracaval extension of tumor thrombus (n=29). Surgical extirpation with cardiac bypass techniques was evaluated on Intraoperative mortality and residual disease. In 29 patients with adrenocortical carcinoma and intracaval extension, cardiac bypass techniques were used in 14 patients with no intraoperative mortalities, supporting complete surgical extirpation.

synapsesocial.com/papers/6aa036e3e74ec63e372d27c8 https://doi.org/10.1016/s0022-5347(01)68152-7

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Adrenocortical Carcinoma With Intracaval Extension

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Adrenocortical Carcinoma With Intracaval Extension

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

Also Consider