Role of reoperation in recurrence of adrenal cortical carcinoma: results from 188 cases collected in the Italian National Registry for Adrenal Cortical Carcinoma.
BACKGROUND
Recurrence of adrenal cortical carcinoma (ACC) after radical surgery is a common finding. Although successful reoperations have been reported with encouraging results, most published experiences are anecdotal and based on few cases. We report the results of surgical treatment for recurrent ACC in a multiinstitutional series.


METHODS
One hundred eighty-eight cases of ACC were collected in a national registry. A complete follow-up was obtained in 179 cases. At initial diagnosis 92 patients had local disease (stage I or II). One hundred seventy patients underwent surgical treatment, considered radical in 140; in this group, recurrent disease was observed in 52 cases (37%) after a mean disease-free interval of 21.7 months.


RESULTS
Adjuvant chemotherapy was ineffective in ameliorating the prognosis. The mean survival in 20 patients who underwent reoperation was significantly higher (15.85 +/- 14.9 months) than in nonreoperated cases (3.2 +/- 2.9 months). Five-year actuarial survival in reoperated patients is significantly better than in nonreoperated patients (49.7% versus 8.3%, respectively).


CONCLUSIONS
Although the prognosis of this tumor is still poor, surgery is the only effective therapy; reoperation allows survival comparable to that observed in patients without recurrent disease. An aggressive strategy for recurrent ACC is advisable until prospective studies demonstrate a real effectiveness for chemotherapy.
Bellantone
R
R
Istituto di Clinica Chirurgica, Policlinico Universitario A Gemelli, Rome, Italy.
Ferrante
A
A
Boscherini
M
M
Lombardi
C P
CP
Crucitti
P
P
Crucitti
F
F
Favia
G
G
Borrelli
D
D
Boffi
L
L
Capussotti
L
L
Carbone
G
G
Casaccia
M
M
Cavallaro
A
A
Del Gaudio
A
A
Dettori
G
G
Di Giovanni
V
V
Mazziotti
A
A
Marrano
D
D
Masenti
E
E
Miccoli
P
P
Mosca
F
F
Mussa
A
A
Petronio
R
R
Piat
G
G
Marazano
L
L
D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012086:Reoperation