The impact of adrenal tumor multidisciplinary team meetings on clinical outcomes
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CLINICAL MANAGEMENT OF ENDOCRINE DISEASES
The impact of adrenal tumor multidisciplinary team meetings on clinical outcomes Hidenori Fukuoka1 Katsumi Shigemura 2,3 Maki Kanzawa4 Tomonori Kanda5 Masaaki Yamamoto1 Koichi Kitagawa3,6 Mariko Sakamoto2 Genzo Iguchi7,8 Wataru Ogawa9 Masato Fujisawa2 Yutaka Takahashi9 ●
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Received: 22 February 2020 / Accepted: 19 May 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Multidisciplinary team meetings (MDMs) to address various clinical problems have become common, especially for cancer care. However, the impact of MDMs on adrenal tumor care has rarely been reported. We organized an endocrine tumor MDM including adrenal tumors in August 2014. The objective of this study was to assess the impact of our adrenal tumor MDMs on patient clinical outcomes. We compared several parameters measuring clinical outcomes before and after MDMs were instituted. Methods The adrenal tumor MDMs included an endocrinologists, urologists, radiologists, pathologists, and residents. We analyzed 128 consecutive cases of functioning adrenal tumors (primary aldosteronism (PA), n = 53; Cushing’s syndrome (CS), n = 24; pheochromocytoma (PCC), n = 51) who underwent surgery in Kobe University Hospital from 2008 to 2019, and compared clinical parameters before (n = 68) and after (n = 60) MDMs were instituted. Results Twenty-one selected cases including PA, CS, PCC, adrenocortical carcinoma, and metastatic adrenal tumor were discussed in the MDM. In the analysis of 128 cases, the difference between pre- and postoperative systolic BP (ΔBP) in patients with PA after MDMs were instituted was smaller compared with those before (p = 0.02). In CS, preoperative steroid synthesis inhibitors were used more often (33 vs. 100%, p < 0.01), postoperative plasma ACTH levels were higher (29.1 vs. 84.5 pg/mL, p < 0.01), and postoperative decrease in systolic BP was milder (p < 0.01) after MDMs were instituted. In PCC, doses of preoperative doxazosin were higher (p < 0.01) after MDMs institution. Operating time, bleeding volume, and cure rate did not differ between each tumor type. Conclusions These data suggest that instituting MDMs improved the perioperative management of functioning adrenal tumors. Keywords Multidisciplinary meeting Primary aldosteronism Cushing’s syndrome Pheochromocytoma Education Perioperative management ●
* Katsumi Shigemura [email protected] 1
Division of Diabetes and Endocrinology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
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Division of Urology, Department of Organ Therapeutics, Faculty of Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
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Department of Public Health, Kobe University Graduate School of Health Science, 7-10-2 Tomogaoka, Suma-ku, Kobe 654-0142, Japan
4
Department of Diagnostic Pathology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, CKobe 650-0017, Japan
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