AUTHOR=Zhang Fan , Liu Zhihong , Feng Dechao , Tang Yongquan , Liu Shenzhuo , Wu Kan , Zhang Fuxun , Zhu Yuchun , Lu Yiping 

TITLE=Reoperation for Recurrent Adrenocortical Carcinoma: A Systematic Review and Pooled Analysis of Population-Based Studies

JOURNAL=Frontiers in Surgery

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.781406

DOI=10.3389/fsurg.2022.781406

ISSN=2296-875X

ABSTRACT=<sec><title>Background</title><p>Adrenocortical carcinoma (ACC) is a rare neoplasm with a high recurrence rate. This study aimed to assess the role of surgery in the clinical management of recurrent ACC.</p></sec><sec><title>Methods</title><p>The PubMed, Embase, Web of Science, and Cochrane Library databases were searched, and the hazard ratios were pooled.</p></sec><sec><title>Results</title><p>Patients who underwent resection for recurrence had significantly better OS or OS after recurrence than those who received only nonsurgical treatments (HR 0.34, <italic>p</italic> &lt; 0.001). Prognostic factors were associated with decreased OS after recurrence, including multiple recurrence (HR 3.23, <italic>p</italic> = 0.001), shorter disease-free interval (HR 2.94, <italic>p</italic> &lt; 0.001), stage III-IV of the original tumor (HR 6.17, <italic>p</italic> = 0.001), sex of male (HR 1.35, <italic>p</italic> = 0.04), and initial non-R0 resection (HR 2.13, <italic>p</italic> = 0.001). Prolonged OS after recurrence was observed in those who experienced incomplete resection (HR 0.43, 95% CI 0.31–0.52, I<sup>2</sup> = 53%) compared with patients who only received nonsurgical treatments. In the reoperated group, patients who underwent complete resection of recurrence had a prolonged OS after recurrence compared with those who underwent incomplete resection (HR 0.23, <italic>p</italic> = 0.004).</p></sec><sec><title>Conclusions</title><p>We confirmed the role of reoperation in the clinical management of recurrent ACC. Select patients might benefit from debulking surgery. The preoperative evaluation of the complete resection of the recurrence is the key means to decide whether patients should undergo surgery. Other prognostic factors associated with prolonged OS include single recurrence site, relatively longer disease-free interval, stage I-II of the original tumor, and female sex.</p></sec>