In the surgical treatment of adrenocortical carcinoma (ACC), lymphadenectomy may improve oncologic outcome. However, patterns of metastatic lymphatic spread in ACC are unknown.
Clinical data of patients included in the European Network for the Study of Adrenal Tumors (ENSAT) registry were retrospectively reviewed. Inclusion criteria were: nonmetastatic ACC, complete resection of the primary tumor, a disease-free time of > 3 months, and lymph node metastases as the first disease relapse. The retroperitoneal lymphatic drainage area was evaluated by using follow-up imaging.
Of 971 patients from the ENSAT registry, 56 patients were included. In left-sided ACC (n = 36), lymphatic recurrence was detected in the left renal hilum (50%), in the perirenal fat tissue cranial to the renal hilum (ventral, 47%; dorsal, 55%), para-aortic (47%), interaorto-caval (22%), and/or in the perirenal fat tissue caudal to the renal hilum (ventral, 20%; dorsal, 17%). In right-sided ACC (n = 20), lymph node metastases were detected in the perirenal fat tissue cranial to the renal hilum (dorsal, 55%; ventral, 45%), interaorto-caval (35%), in the area of the right renal artery (10%), and/or paracaval (15%). Patients with right-sided ACC showed left-paraaortic lymph node recurrences in 10% of cases.
Metastatic lymphatic spread appears to be more extensive than previously thought. The distribution pattern of lymph node metastases described in our study could be used as a guide for a more extended lymph node dissection.
Annals of surgical oncology. 2018 Nov 15 [Epub ahead of print]
Joachim Reibetanz, Britta Rinn, Andreas S Kunz, Sven Flemming, Cristina L Ronchi, Matthias Kroiss, Timo Deutschbein, Alina Pulzer, Stefanie Hahner, Arkadius Kocot, Christoph-Thomas Germer, Martin Fassnacht, Christian Jurowich
Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany. ., Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany., Institute of Diagnostic and Interventional Radiology, University Hospital, University of Würzburg, Würzburg, Germany., Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany., Department of Urology and Pediatric Urology, University Hospital, University of Würzburg, Würzburg, Germany., Department of General, Viszeral, and Thoracic Surgery, Kreisklinik Altötting, Altötting, Germany.