[Resection strategies for adrenocortical carcinoma]

Area of Science:

• Oncology
• Surgical Oncology

Background:

• Adrenocortical carcinoma (ACC) is a rare and aggressive endocrine neoplasm.
• High rates of recurrence (up to 85%) and metastasis lead to poor patient survival.
• 5-year survival is 50% with lymph node metastasis and <15% with distant metastasis.

Purpose of the Study:

• To outline the optimal management strategy for adrenocortical carcinoma.
• To emphasize the importance of specialized centers for ACC treatment.
• To discuss surgical approaches, including minimally invasive techniques.

Main Methods:

• Review of current treatment protocols and surgical outcomes for ACC.
• Analysis of prognostic factors influencing survival in ACC patients.
• Comparison of open versus minimally invasive surgical techniques for ACC resection.

Main Results:

• R0 resection with locoregional and extended lymphadenectomy is the only curative treatment.
• Minimally invasive laparoscopic resection offers comparable survival to open surgery when oncological principles are followed.
• Debulking non-resectable ACC is not recommended; palliative resection is reserved for symptomatic patients.

Conclusions:

• Multidisciplinary management in specialized centers is crucial for ACC patients.
• Complete surgical resection (R0) is paramount for curative intent.
• Minimally invasive surgery is a viable option for ACC treatment, maintaining oncological safety.