title: Operative management for recurrent and metastatic adrenocortical carcinoma.
abstract: OBJECTIVE
  A review of all resections for recurrent or metastatic ACC was performed to identify patients who might benefit from a surgical approach, and to identify factors that might aid in prognosis among patients with metastatic disease.
  
  
  BACKGROUND
  Adrenocortical carcinoma (ACC) is a rare tumor, with frequent recurrences and metastases even after complete resection. Chemotherapy has limited efficacy, and surgical resection of metastatic ACC remains controversial.
  
  
  METHODS
  A retrospective review was performed of all patients who underwent surgical intervention for metastatic ACC in a single tertiary center from 1977 to 2009. All available clinicopathologic data were analyzed to determine potential factors associated with response to treatment and survival.
  
  
  RESULTS
  Fifty-seven patients underwent 116 procedures for recurrent or metastatic disease. Twenty-three resections were for liver metastases, 48 for pulmonary metastases, 22 for abdominal disease including local recurrences, and 13 were for metastases at other sites. Median and 5-year survivals from time of first metastasectomy were 2.5 years, and 41%, respectively. The median survival of patients with DFI <12 months was 1.7 years, compared to 6.6 years for patients with DFI >12 months (P = 0.015). Median survival for right versus left-sided primaries was 1.9 years versus 3.8 years (P = 0.03). Liver metastases were more common with right-sided primaries (67% vs. 41%, P = 0.05). Chemotherapy had no impact on survival.
  
  
  CONCLUSIONS
  Resection of recurrent or metastatic ACC is safe, and may result in prolongation of survival in selected patients with DFI greater than 1 year.
authors.affiliation: Surgery Branch, National Cancer Institute/NIH, Building 10-Hatfield CRC Room 4-3961, 10 Center Drive, Bethesda, MD 20892, USA.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Datrice
authors.forename: Russell C
authors.initials: RC
authors.lastname: Langan
authors.forename: R Taylor
authors.initials: RT
authors.lastname: Ripley
authors.forename: Clinton D
authors.initials: CD
authors.lastname: Kemp
authors.forename: Seth M
authors.initials: SM
authors.lastname: Steinberg
authors.forename: Bradford J
authors.initials: BJ
authors.lastname: Wood
authors.forename: Steven K
authors.initials: SK
authors.lastname: Libutti
authors.forename: Tito
authors.initials: T
authors.lastname: Fojo
authors.forename: David S
authors.initials: DS
authors.lastname: Schrump
authors.forename: Itzhak
authors.initials: I
authors.lastname: Avital
mesh_terms: D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018268:Adrenocortical Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies