{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:39:19Z","timestamp":1747183159190,"version":"3.40.5"},"reference-count":47,"publisher":"Wiley","issue":"1-2","license":[{"start":{"date-parts":[[2020,7,5]],"date-time":"2020-07-05T00:00:00Z","timestamp":1593907200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Adrenocortical carcinoma is a rare but aggressive form of endocrine neoplasm that confers a poor prognosis. To date, the only Australian data published is from New South Wales. This paper describes our experience in Western Australia with a focus on surgical approach and outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective study of patients treated for adrenocortical carcinoma in Western Australia over 14\u2009years was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over the 14\u2010year period, a total of 33 patients underwent surgery for adrenocortical carcinoma. Resection outcomes were superior in an open en bloc approach with an 85% R0 margin (<jats:italic>P<\/jats:italic>\u2009=\u20090.007). Local recurrence rates were lowest in an open en bloc approach (11%) compared to laparoscopic (75%). Multivariate analysis showed that an en bloc resection is highly correlated with an R0 resection (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05) and significantly associated with lower (odds ratio = 0.06) local recurrence (<jats:italic>P<\/jats:italic> = 0.009). Higher volume surgeons (&gt;5 cases) had lower operative times and blood loss. Compliance with mitotane was significantly improved with close monitoring of levels. The European Network for the Study of Adrenal Tumours (ENSAT) stage at presentation was most predictive of long\u2010term survival with 100% of stage I patients alive compared to 53% of stage II, 25% of stage III and 17% of stage IV patients at the end of the follow\u2010up period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>An open en bloc approach with a low threshold for multi\u2010visceral resection performed by high volume surgeons have improved outcomes in local recurrence, operative times and blood loss.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.16111","type":"journal-article","created":{"date-parts":[[2020,7,6]],"date-time":"2020-07-06T06:47:27Z","timestamp":1594018047000},"page":"62-67","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Management of adrenocortical carcinoma in Western Australia: a perspective over 14\u2009years"],"prefix":"10.1111","volume":"91","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4552-9579","authenticated-orcid":false,"given":"David","family":"Leong","sequence":"first","affiliation":[{"name":"Department of Endocrine Surgery Sir Charles Gairdner Hospital  Perth Western Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Munyaradzi","family":"Nyantoro","sequence":"additional","affiliation":[{"name":"Department of General Surgery Fiona Stanley Hospital  Perth Western Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hira","family":"Shedzad","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery Sir Charles Gairdner Hospital  Perth Western Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Robins","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine Sir Charles Gairdner Hospital  Perth Western Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Henley","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery Sir Charles Gairdner Hospital  Perth Western Australia Australia"},{"name":"Department of Endocrinology and Diabetes Sir Charles Gairdner Hospital  Nedlands Western Australia Australia"},{"name":"School of Medicine and Pharmacology University of Western Australia  Crawley Western Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Ryan","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery Sir Charles Gairdner Hospital  Perth Western Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hieu","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery Sir Charles Gairdner Hospital  Perth Western Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dean","family":"Lisewski","sequence":"additional","affiliation":[{"name":"School of Medicine and Pharmacology University of Western Australia  Crawley Western Australia Australia"},{"name":"Department of Endocrine Surgery Fiona Stanley Hospital  Perth Western Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,7,5]]},"reference":[{"doi-asserted-by":"publisher","key":"e_1_2_8_2_1","DOI":"10.3322\/canjclin.37.6.348"},{"doi-asserted-by":"publisher","key":"e_1_2_8_3_1","DOI":"10.1002\/cncr.23886"},{"doi-asserted-by":"publisher","key":"e_1_2_8_4_1","DOI":"10.1007\/978-1-4419-0857-5"},{"doi-asserted-by":"publisher","key":"e_1_2_8_5_1","DOI":"10.1016\/j.soc.2015.08.011"},{"issue":"179","key":"e_1_2_8_6_1","first-page":"pii: EJE\u201018\u2010060","article-title":"European Society of Endocrinology clinical practice guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors","volume":"4","author":"Fassnacht M","year":"2018","journal-title":"Eur. 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