[Malignant cortico-adrenal tumors with vena cava extension. Is surgical resection justified?]

Between January 1989 and December 1996, 6 patients (4 females and 2 males), ranging in age from 23 to 82, underwent surgery for malignant adrenocortical tumors with inferior vena cava extension. There were 5 adrenocortical carcinomas and 1 metastasis from a differentiated thyroid carcinoma. The tumor size ranges from 9 to 17 cm. 5 tumors involved the right adrenal and 1 involved the left adrenal. Four patients had a vena caval thrombus, extending into the right atrium in one case. Two patients had direct tumoral invasion of the IVC wall without thrombius. All patients underwent en bloc excision of the adrenal gland and regional nodes, with nephrectomy in 4 cases and right hepatectomy in one case. Thrombectomy was performed in 4 cases with cardio-pulmonary by-pass in one case. Venous invasion without thrombus required total resection of the infra-hepatic IVC ine one case and vascular reconstruction with prosthetic patch in another case. There were no peri-operative deaths. Two patients died from metastatic disease after 13 and 40 months respectively. Four patients were alive with a follow-up ranging from 3 to 31 months, 3 patient were free of disease. Surgical resection of adrenocortical carcinomas with IVC extension can be attempted. There is no increase in morbidity and mortality in comparison with surgical treatment of other adrenal carcinomas. In these particular cases, the risk of metastases and local recurrence is high, but long-term survival can be obtained after radical macroscopic resection.