title: Combined liver and inferior vena cava resection for adrenocortical carcinoma.
abstract: OBJECTIVE
  Adrenocortical carcinoma (ACC) is a rare malignancy, usually diagnosed at an advanced stage when it has invaded or adhered to adjacent organs. We report our experience of performing combined liver and inferior vena cava (IVC) resection for ACC.
  
  
  METHODS
  Six patients with clinical stage III (n = 4) or IV (n = 2) ACC underwent combined resection of the liver and IVC. Two patients underwent extended right hepatectomy, and four underwent segmentectomy. In four patients, the IVC was resected segmentally: it was replaced with expanded polytetrafluoroethylene (ePTFE) in three of these patients, and not reconstructed in one. In two patients, the IVC was partially resected and closed directly.
  
  
  RESULTS
  Perioperative mortality was zero, and morbidity was 33.3%, with temporary liver failure in two patients and renal failure in one patient. Recurrence was found within 8.1 months in three (50%) of the six patients. The mean recurrence-free survival period was 20.1 +/- 7.7 months (95% confidence interval [CI]: 5.1-35.4), and the median survival time was 6.1 +/- 9.8 months (95% CI: 00-25.3). The 5-year disease-free survival rate was 16.7%.
  
  
  CONCLUSIONS
  Patients with ACC involving both the liver and IVC are candidates for partial hepatectomy and segmental IVC resection. Resection affords the possibility of negative margins, acceptable perioperative morbidity and mortality, and prolonged survival in some patients.
authors: Department of Surgery, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
authors: Susumu
authors: S
authors: Ohwada
authors: Masaru
authors: M
authors: Izumi
authors: Yoshifumi
authors: Y
authors: Tanahashi
authors: Susumu
authors: S
authors: Kawate
authors: Kunihiro
authors: K
authors: Hamada
authors: Hirofumi
authors: H
authors: Tsutsumi
authors: Jun
authors: J
authors: Horiguchi
authors: Yukio
authors: Y
authors: Koibuchi
authors: Toru
authors: T
authors: Takahashi
authors: Masanobu
authors: M
authors: Yamada
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000473:pathology* / Q000601:surgery*; D018268:Adrenocortical Carcinoma / Q000556:secondary* / Q000601:surgery*; D000328:Adult; D000368:Aged; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011138:Polytetrafluoroethylene; D015996:Survival Rate; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*
chemical_list: D011138:Polytetrafluoroethylene