Schimmack S, Strobel O
Klinik für Allgemein‑, Viszeral und Transplantationschirurgie, Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
Chirurg. 2019 Jan;90(1):9-14. doi: 10.1007/s00104-018-0712-4.
Adrenocortical carcinomas (ACC) are rare and aggressive neoplasms. Due to their high rate of local recurrence and distant metastases (up to 85%) they are associated with a poor survival. The 5‑year survival in ACC patients with lymph node metastasis or local infiltration is 50% and with distant metastasis less than 15%. An R0 resection with locoregional and para-aortic/paracaval lymphadenectomy is the only curative option and reasonable treatment possibility. The treatment of these patients should therefore be planned and carried out in centers. Local recurrences and distant metastases should also be treated with R0 resection when feasible, combined with neoadjuvant/adjuvant chemotherapy and/or radiation. In the case of an asymptomatic non-resectable ACC, debulking operations cannot be recommended. The primary operation can also be done in a minimally invasive procedure if principles of oncological surgery are followed (radical resection, no damage of the tumor capsule, lymphadenectomy), since survival after open and minimally invasive laparoscopic resection was comparable. Palliative resections are only indicated in symptomatic patients.
肾上腺皮质癌（ACC）是罕见的侵袭性肿瘤。由于其局部复发和远处转移率高（高达85%），其生存率较低。伴有淋巴结转移或局部浸润的ACC患者5年生存率为50%，伴有远处转移的患者5年生存率低于15%。行R0切除并进行局部及主动脉旁/腔静脉旁淋巴结清扫是唯一的治愈性选择和合理的治疗方案。因此，这些患者的治疗应在专科中心进行规划和实施。对于局部复发和远处转移，可行时也应行R0切除，并联合新辅助/辅助化疗和/或放疗。对于无症状的不可切除ACC，不建议行减瘤手术。如果遵循肿瘤外科手术原则（根治性切除、不损伤肿瘤包膜、淋巴结清扫），原发性手术也可采用微创手术，因为开放手术和微创腹腔镜切除后的生存率相当。姑息性切除仅适用于有症状的患者。
