Surgical management of adrenal cortical carcinoma

The experience with the surgical management of 14 patients with adrenal cortical carcinoma is presented. Four patients were males and 10 females (mean age: 37 years). Seven patients (50%) has proven hormonal activity and 7 (50%) had "non functioning" tumors. The location of carcinoma involved the left adrenal gland in 9 cases, the right in 3 and it was bilateral in 2. The mean diameter of the mass was 10 cm. The most helpful diagnostic tests were shown to be sonography and computed tomography. The surgical procedure was chosen according to the patients condition: this included resection of primary lesion and excision of local lymph nodes and all involved structures. Adjuvant treatment with either mitotane, 5-FU or local irradiation did not result in any benefit with respect to the expected survival. There was a slightly better survival for functioning versus non functioning tumors. Surgery remains the treatment of choice for these tumors. Prognosis is exceedingly poor: only 5 patients (36%) have survived beyond two years after surgery.