The impact of adrenal tumor multidisciplinary team meetings on clinical outcomes.

Abstract

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. 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. 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. These data suggest that instituting MDMs improved the perioperative management of functioning adrenal tumors.