Surgery for adrenocortical carcinoma: When and how?

Area of Science:

• Oncology
• Surgical Oncology
• Radiology

Background:

• Adrenocortical carcinoma (ACC) is a rare endocrine malignancy.
• Often presents with metastatic disease and has a poor prognosis, especially cortisol-producing tumors.
• Complete surgical resection is the cornerstone of ACC management.

Purpose of the Study:

• To emphasize the critical role of surgical resection in adrenocortical carcinoma (ACC) treatment.
• To highlight the importance of accurate staging and surgical approach for optimal patient outcomes.
• To underscore the significance of surgeon and center volume in achieving superior results.

Main Methods:

• Accurate staging using triphasic CT scans and FDG-PET/CT.
• MRI for evaluating liver metastasis and adjacent organ involvement.
• Open adrenalectomy as the gold standard for R0 resection.

Main Results:

• Complete surgical resection with negative margins is the most significant prognostic factor for ACC survival.
• Maintaining tumor capsule integrity during surgery is vital.
• High-volume surgeons and centers achieve better post-operative oncologic and complication outcomes.

Conclusions:

• Surgical management, particularly complete resection, is paramount for adrenocortical carcinoma (ACC) patients.
• Advanced imaging techniques are essential for precise staging and surgical planning.
• Centralization of care at high-volume institutions improves patient outcomes.