Patterns of lymph node recurrence in adrenocortical carcinoma: possible implications for primary surgical treatment

Research output: Contribution to journalArticlepeer-review


  • Joachim Reibetanz
  • Britta Rinn
  • Andreas S. Kunz
  • Sven Flemming
  • Matthias Kroiss
  • Timo Deutschbein
  • Alina Pulzer
  • Stefanie Hahner
  • Arkadius Kocot
  • Christoph-Thomas Germer
  • Martin Fassnacht
  • Christian Jurowich

Colleges, School and Institutes


Background: In the surgical treatment of adrenocortical carcinoma (ACC), lymphadenectomy may improve oncologic outcome. However, patterns of metastatic lymphatic spread in ACC are unknown.

Methods: 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.

Results: 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.

Conclusion: 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.


Original languageEnglish
Pages (from-to)531–538
Number of pages8
JournalAnnals of Surgical Oncology
Issue number2
Early online date15 Nov 2018
Publication statusPublished - 15 Feb 2019

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