La strategia chirurgica nel trattamento del carcinoma cortico surrenalico. Gli interventi allargati ed iterativi


COD: 2003_03_311-318 Categorie: ,

D. Borrelli, C. Bergamini, A. Borrelli, S. Reddavide, R. Lassig, A. Valeri

Ann. Ital. Chir., LXXIV, 3, 2003

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Aim of the study: To analyze our patients affected by adreno-cortical carcinoma (ACC) considering in particular the therapeutical approach in case of local recurrence or metastasis, and to compare our results with those from literature.
Patients and methods: Since 1975 up to 2001, 35 patients with ACC were observed, 27 female and 8 male, aged between 3 and 76 year. All patients were surgically treated, 3 out of which laparoscopically. Thirty patients underwent radical and 5 palliative surgery. Twenty-two patients had extended resections to surrounding infiltrated organs, such as spleen, pancreatic tale, vena cava, left colon and liver. The
intervention was always completed by regional limphadenectomy. Adjuvant treatment was administered in 17 patients, 4 out of which were re-operated. Results: only one patient died in the perioperative period for hyperacute adrenal failure. The survival rate was 85.7% at one year, 76.5% at two years, 70.8% at three and 28.3% at five years. Out of the 30 patients radically treated, only 3 are disease-free up to now. Local recurrence or metastatic disease was observed in 27 patients, out of which only 9 were eventually surgically treated, once or more times. All non-operated patients died between 1 and 6 months from the recurrence. The survival rate of the 9 re-operated patients was 51% at 2 years, and 22,1% at 5 years. Interestingly, one patient who has been re-operated three times, is still alive and disease-free after 7 years from the first recurrence. No significant difference was observed between Mitotane treated and non-treated patients.