Surgical treatment of adrenal carcinoma

J Visc Surg. 2017 Oct;154(5):335-343. doi: 10.1016/j.jviscsurg.2017.06.010. Epub 2017 Jul 25.

Abstract

Adrenocortical carcinoma (ACC) is a rare disease with a poor prognosis. The presence of a mass syndrome or signs of hormonal hypersecretion often lead to its discovery, but more and more frequently, adrenocortical malignancy is fortuitously discovered as an incidentaloma. Cross-sectional imaging (CT and MRI) often points to the malignant character of the adrenal mass. Needle biopsy is contraindicated. Laboratory testing showing combined hypersecretion of cortisol, androgens or inactive corticosteroid precursors is highly suggestive of ACC. An 18F-fluoro-deoxyglucose Positron Emission Tomography (PET scan) should be performed to evaluate the malignancy of an adrenal mass and to detect regional or distant metastases. Although the majority of ACC are diagnosed at a locally advanced or metastatic stage, radical resection offers the only hope of cure. The peri-operative management of patients with ACC is not yet standardized. The aim of this review is to summarize the actual knowledge of the surgical management of ACC.

Keywords: Adrenal gland; Adrenal incidentaloma; Adrenalectomy; Adrenocortical carcinoma.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Neoplasms / diagnostic imaging*
  • Adrenal Cortex Neoplasms / mortality
  • Adrenal Cortex Neoplasms / pathology
  • Adrenal Cortex Neoplasms / surgery*
  • Adrenalectomy / methods*
  • Adrenalectomy / mortality
  • Adrenocortical Carcinoma / diagnostic imaging*
  • Adrenocortical Carcinoma / mortality
  • Adrenocortical Carcinoma / pathology
  • Adrenocortical Carcinoma / surgery*
  • Disease-Free Survival
  • Female
  • Humans
  • Laparoscopy / methods
  • Laparotomy / methods
  • Magnetic Resonance Imaging / methods
  • Male
  • Neoplasm Invasiveness / pathology
  • Neoplasm Staging
  • Positron Emission Tomography Computed Tomography / methods
  • Prognosis
  • Rare Diseases
  • Risk Assessment
  • Survival Analysis
  • Treatment Outcome