title: Surgical outcome of stage III and IV adrenocortical carcinoma.
abstract: BACKGROUND
  Adrenocortical carcinoma (ACC) is a rare tumor usually diagnosed at an advanced stage on invasion of or adherence to adjacent organs. We report surgical outcome of stage III and IV ACCs.
  
  
  METHODS
  ACCs from seven patients at clinical stage II (n = 1), III (n = 4), or IV (n = 2) were resected. Combined resection of the liver and inferior vena cava was performed in six patients. Morbidity, mortality, recurrence and survival were analyzed.
  
  
  RESULTS
  The pathological stage was stage III in five patients and stage IV in two patients. The mortality was zero and the morbidity was two of seven (29%) patients. The estimated 3-year disease-free and overall survivals for stage III were 20% and 40%, respectively, with a median follow-up of 32 months (range, 11-58). The mean disease-free survival was 21.0 +/- 9.0 months (95% CI: 3.3-38.7). The 3-year disease-free and overall survivals for stage III and IV were 14.3% and 28.6%, respectively. The mean disease-free survival time was 18.6 +/- 6.7 months (95% CI: 5.4-31.8). The most frequent site of metastasis was the lungs, seen in four patients, and liver in three patients. Loco-regional, intra-abdominal lymph node, peritoneum, bone, brain recurrences were also seen in one patient each. The mean survival after recurrence was 19.0 +/- 3.3 months (95% CI: 12.6-25.5), and the 50% survival was 18.4 months with mitotan and cytotoxic drug therapy.
  
  
  CONCLUSIONS
  Resection for stage III, IV ACCs affords the possibility of negative margins, acceptable peri-operative morbidity and mortality, and prolongs survival in selected patients.
authors.affiliation: Department of Surgery, Gunma University School of Medicine, 3Maebashi, Gunma, Japan. sohwada@med.gunma-u.ac.jp
authors.forename: Susumu
authors.initials: S
authors.lastname: Ohwada
authors.forename: Masaru
authors.initials: M
authors.lastname: Izumi
authors.forename: Susumu
authors.initials: S
authors.lastname: Kawate
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Hamada
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Toya
authors.forename: Nozomi
authors.initials: N
authors.lastname: Togo
authors.forename: Jun
authors.initials: J
authors.lastname: Horiguchi
authors.forename: Yukioi
authors.initials: Y
authors.lastname: Koibuchi
authors.forename: Toru
authors.initials: T
authors.lastname: Takahashi
authors.forename: Masanobu
authors.initials: M
authors.lastname: Yamada
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000473:pathology / Q000601:surgery*; D018268:Adrenocortical Carcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016019:Survival Analysis; D014682:Vena Cava, Inferior / Q000601:surgery