The surgical management of adrenal cortical carcinoma.

Experience with the surgical treatment of 12 patients with carcinoma of the adrenal cortex is presented. They were 6 men and 6 women. Their ages ranged from 23 to 66 years old (mean 38 years). Four carcinomas had detected hormonal activity. The location of the carcinoma involved the right adrenal in 8 cases and the left in 4 cases. The mean diameter of the mass was 15 cm. Excision of the adrenal cancer with the ipsilateral kidney was the usual procedure. Lymph nodes were involved in 5 cases and interestingly the kidney was only involved in 3 cases. One patient died during hospitalization from pulmonary embolus, whereas another one required re-exploration for postoperative hemorrhage. Nine patients developed pulmonary, hepatic and bone metastasis within 3 to 10 months, postoperatively. Radiation treatment and chemotherapy had poor results. Nevertheless, one patient in whom left adrenalectomy, splenectomy and partial pancreatectomy was performed, is doing well, despite the presence of hepatic metastases, with the addition of o,p' DDD, 24 months postoperatively. Another patient underwent reoperation and excision of recurrent local disease 12 months after adrenalectomy/nephrectomy. She is now alive 16 months following her second surgery. Based on the above, an aggressive surgical approach is advocated in the management of adrenocortical carcinoma.