Introduction: Adrenocortical carcinoma (ACC) is a rare malignancy of the adrenal cortex with a poor prognosis. We hypothesized that ACC patients are at high risk for venous thromboembolism (VTE), given the numerous risk factors such as malignancy, abdominal surgery, immobility and hormonal excess. The aim of this study was to examine the incidence of VTE after surgical treatment in ACC patients.
Methods: A retrospective study was performed, collecting data from all patients diagnosed with ACC from 2003 to 2018 at the Radboud University Nijmegen Medical Centre, The Netherlands.
Results: In total, 34 patients were included in the study. The majority of the patients was female (67.6%), and the median age was 60 years. Of the 34 ACCs, 23 (76.7%) exhibited hormonal excess. The most common type of hormonal overproduction was overt hypercortisolism (23.5%). The average tumor size was 13.6 cm. In 34 patients, 8 postoperative VTEs, all pulmonary embolisms, were diagnosed in the first 6 months after adrenalectomy (23.5%). In addition, one patient developed pulmonary embolism just prior to surgery and one patient 7 years after surgery. Five of the 8 patients with postoperative VTE presented with symptomatic pulmonary embolism whereas the other 3 pulmonary embolisms were incidentally found on regular follow up CT scans. Seven of the 8 VTEs occurred within 10 weeks after surgery. Seven of the 8 patients with VTE had an advanced stage ACC (ENSAT stadium 3 and 4 or Mib-1 labeling index > 10%). Four of the 8 patients with VTE received LMWH prophylaxis during the development of the VTE. There was one case of fatal pulmonary embolism in a patient with a cortisol producing ACC with pulmonary metastases, despite the use of a therapeutic dose of LMWH.
Conclusion: Patients with ACC are at high risk of developing postoperative VTE. Prolonged postoperative thromboprophylaxis could be considered in these patients.