title: European Society of Endocrine Surgeons (ESES) and European Network for the Study of Adrenal Tumours (ENSAT) recommendations for the surgical management of adrenocortical carcinoma.
abstract: BACKGROUND
  Radical surgery provides the best chance of cure for adrenocortical carcinoma (ACC), but perioperative surgical care for these patients is yet to be standardized.
  
  
  METHODS
  A working group appointed jointly by ENSAT and ESES used Delphi methodology to produce evidence-based recommendations for the perioperative surgical care of patients with ACC. Papers were retrieved from electronic databases. Evidence and recommendations were classified according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system, and were discussed until consensus was reached within the group.
  
  
  RESULTS
  Twenty-five recommendations for the perioperative surgical care of patients with ACC were formulated. The quality of evidence is low owing to the rarity of the disease and the lack of prospective surgical trials. Multi-institutional prospective cohort studies and prospective RCTs are urgently needed and should be strongly encouraged.
  
  
  CONCLUSIONS
  The present evidence-based recommendations provide comprehensive advice on the optimal perioperative care for patients undergoing surgery for ACC.
authors.affiliation: Department of Digestive and Endocrine Surgery, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.|Faculté de Médecine Paris Descartes, Université Paris Descartes, Paris, France.|Institut National de la Santé et de la Recherche Médicale (INSERM) Unit 1016, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Institut Cochin, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Gaujoux
authors.affiliation: Churchill Cancer Centre, Oxford University Hospitals Foundation Trust, Oxford, UK.
authors.forename: R
authors.initials: R
authors.lastname: Mihai
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D018268:Adrenocortical Carcinoma / Q000000981:diagnostic imaging / Q000601:surgery*; D000359:Aftercare; D065426:Cytoreduction Surgical Procedures / Q000379:methods; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D008487:Medical History Taking / Q000379:methods; D008499:Medical Records; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000601:surgery; D009378:Neoplasms, Multiple Primary / Q000601:surgery; D016609:Neoplasms, Second Primary / Q000601:surgery; D059351:Organ Sparing Treatments / Q000379:methods; D010166:Palliative Care / Q000379:methods; D010808:Physical Examination / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D012017:Referral and Consultation; D014057:Tomography, X-Ray Computed / Q000379:methods