Skip to main content


Log in

Adrenocortical carcinoma surgery—surgical extent and approach

  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript



Adequate tumour resection is the gold standard of care for adrenocortical carcinoma (ACC). However, the optimal surgical strategy remains debatable. In our opinion, the extent of surgery (adequate tumour resection) is the primary concern, rather than the surgical approach (laparoscopic or open). We propose that both surgical approaches have a role in the management of ACC provided the extent of resection is selected based on patient and tumour characteristics and accurate pre-operative investigations.


A review of 25 curative intent resections for ACC between 2002 and 2013 was done. Group A (16 patients—64 %) included all patients who underwent planned radical adrenalectomy without any other resection and group B (9 patients—36 %) included all patients who underwent a planned extensive resection based on pre-operative investigations.


Of 471 adrenalectomies, 25 were performed for ACC with curative intent. Tumours were significantly larger in group B with mean size of 119.6 versus 62.4 mm in group A (p = 0.002). Tumours in group B also had higher WEISS scores (mean score 7 vs 5.2, p = 0.033) and almost always required multi-organ resection. The recurrence rate was 37.5 % (n = 6) for group A and 44.4 % for group B (n = 4), p = 1.00. Poor prognosis was associated with significantly higher WEISS scores (p = 0.016) and a trend towards more advanced ENSAT disease stage (p = 0.06). Estimated overall survival was 74.17 months (group A 67.3 vs group B 70.1, p = 0.244).


Accurate pre-operative staging is critical to select a tailored surgical strategy. Multi-organ resection remains the preferred approach for large and potentially invasive ACC. Some patients presenting with smaller ACC may benefit from a more extensive resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others


  1. Allolio B, Fassnacht M (2006) Clinical review: adrenocortical carcinoma: clinical update. J Clin Endocrinol Metab 91:2027–2037. doi:10.1210/jc.2005-2639

    Article  CAS  PubMed  Google Scholar 

  2. Dackiw AP, Lee JE, Gagel RF, Evans DB (2001) Adrenal cortical carcinoma. World J Surg 25:914–926

    Article  CAS  PubMed  Google Scholar 

  3. Siegel R, Naishadham D, Jemal A (2012) Cancer statistics, 2012. CA Cancer J Clin 62:10–29. doi:10.3322/caac.20138

    Article  PubMed  Google Scholar 

  4. Bilimoria KY, Shen WT, Elaraj D, et al. (2008) Adrenocortical carcinoma in the United States: treatment utilization and prognostic factors. Cancer 113:3130–3136. doi:10.1002/cncr.23886

    Article  PubMed  Google Scholar 

  5. Schulick RD, Brennan MF (1999) Long-term survival after complete resection and repeat resection in patients with adrenocortical carcinoma. Ann Surg Oncol 6:719–726

    Article  CAS  PubMed  Google Scholar 

  6. Lombardi CP, Raffaelli M, De Crea C, Bellantone R (2006) Role of laparoscopy in the management of adrenal malignancies. J Surg Oncol 94:128–131. doi:10.1002/jso.20599

    Article  PubMed  Google Scholar 

  7. Henry J-F, Sebag F, Iacobone M, Mirallie E (2002) Results of laparoscopic adrenalectomy for large and potentially malignant tumors. World J Surg 26:1043–1047. doi:10.1007/s00268-002-6666-0

    Article  PubMed  Google Scholar 

  8. McCauley LR, Nguyen MM (2008) Laparoscopic radical adrenalectomy for cancer: long-term outcomes. Curr Opin Urol 18:134–138. doi:10.1097/MOU.0b013e3282f3e6d2

    Article  PubMed  Google Scholar 

  9. Porpiglia F, Fiori C, Daffara F, et al. (2010) Retrospective evaluation of the outcome of open versus laparoscopic adrenalectomy for stage I and II adrenocortical cancer. Eur Urol 57:873–878. doi:10.1016/j.eururo.2010.01.036

    Article  PubMed  Google Scholar 

  10. Miller BS, Ammori JB, Gauger PG, et al. (2010) Laparoscopic resection is inappropriate in patients with known or suspected adrenocortical carcinoma. World J Surg 34:1380–1385. doi:10.1007/s00268-010-0532-2

    Article  CAS  PubMed  Google Scholar 

  11. Cooper AB, Habra MA, Grubbs EG, et al. (2013) Does laparoscopic adrenalectomy jeopardize oncologic outcomes for patients with adrenocortical carcinoma? Surg Endosc 27:4026–4032. doi:10.1007/s00464-013-3034-0

    Article  PubMed  Google Scholar 

  12. Mir MC, Klink JC, Guillotreau J, et al. (2013) Comparative outcomes of laparoscopic and open adrenalectomy for adrenocortical carcinoma: single, high-volume center experience. Ann Surg Oncol 20:1456–1461. doi:10.1245/s10434-012-2760-1

    Article  PubMed  Google Scholar 

  13. Lombardi CP, Raffaelli M, De Crea C, et al. (2012) Open versus endoscopic adrenalectomy in the treatment of localized (stage I/II) adrenocortical carcinoma: results of a multiinstitutional Italian survey. Surgery 152:1158–1164. doi:10.1016/j.surg.2012.08.014

    Article  PubMed  Google Scholar 

  14. Mizrahi I, Mazeh H (2014) Role of laparoscopy in rectal cancer: a review. World J Gastroenterol WJG 20:4900–4907. doi:10.3748/wjg.v20.i17.4900

    Article  PubMed  Google Scholar 

  15. Lughezzani G, Sun M, Perrotte P, et al. (2010) The European network for the study of adrenal tumors staging system is prognostically superior to the international union against cancer-staging system: a north American validation. Eur J Cancer Oxf Engl 1990 46:713–719. doi:10.1016/j.ejca.2009.12.007

    Google Scholar 

  16. Jain M, Kapoor S, Mishra A, et al. (2010) Weiss criteria in large adrenocortical tumors: a validation study. Indian J Pathol Microbiol 53:222–226. doi:10.4103/0377-4929.64325

    Article  PubMed  Google Scholar 

  17. Porpiglia F, Miller BS, Manfredi M, et al. (2011) A debate on laparoscopic versus open adrenalectomy for adrenocortical carcinoma. Horm Cancer 2:372–377. doi:10.1007/s12672-011-0095-1

    Article  PubMed  Google Scholar 

  18. Miller BS, Gauger PG, Hammer GD, Doherty GM (2012) Resection of adrenocortical carcinoma is less complete and local recurrence occurs sooner and more often after laparoscopic adrenalectomy than after open adrenalectomy. Surgery 152:1150–1157. doi:10.1016/j.surg.2012.08.024

    Article  PubMed  Google Scholar 

  19. Icard P, Goudet P, Charpenay C, et al. (2001) Adrenocortical carcinomas: surgical trends and results of a 253-patient series from the French Association of Endocrine Surgeons study group. World J Surg 25:891–897

    Article  CAS  PubMed  Google Scholar 

  20. Crucitti F, Bellantone R, Ferrante A, et al. (1996) The Italian Registry for adrenal cortical carcinoma: analysis of a multiinstitutional series of 129 patients. The ACC Italian Registry Study Group Surgery 119:161–170

    CAS  Google Scholar 

  21. Gumbs AA, Gagner M (2006) Laparoscopic adrenalectomy. Best Pract Res Clin Endocrinol Metab 20:483–499. doi:10.1016/j.beem.2006.07.010

    Article  PubMed  Google Scholar 

  22. Imai T, Kikumori T, Ohiwa M, et al. (1999) A case-controlled study of laparoscopic compared with open lateral adrenalectomy. Am J Surg 178:50–53 discussion 54

    Article  CAS  PubMed  Google Scholar 

  23. Lee J, El-Tamer M, Schifftner T, et al. (2008) Open and laparoscopic adrenalectomy: analysis of the National Surgical Quality Improvement Program. J Am Coll Surg 206:953–959 . doi:10.1016/j.jamcollsurg.2008.01.018 discussion 959–961

    Article  PubMed  Google Scholar 

  24. Prinz RA (1995) A comparison of laparoscopic and open adrenalectomies. Arch Surg Chic Ill 1960 130:489–492 discussion 492–494

    CAS  Google Scholar 

  25. Thompson GB, Grant CS, van Heerden JA, et al. (1997) Laparoscopic versus open posterior adrenalectomy: a case-control study of 100 patients. Surgery 122:1132–1136

    Article  CAS  PubMed  Google Scholar 

  26. Brix D, Allolio B, Fenske W, et al. (2010) Laparoscopic versus open adrenalectomy for adrenocortical carcinoma: surgical and oncologic outcome in 152 patients. Eur Urol 58:609–615. doi:10.1016/j.eururo.2010.06.024

    Article  PubMed  Google Scholar 

  27. Jurowich C, Fassnacht M, Kroiss M, et al. (2013) Is there a role for laparoscopic adrenalectomy in patients with suspected adrenocortical carcinoma? A critical appraisal of the literature. Horm Metab Res Horm- Stoffwechselforschung Horm Métabolisme 45:130–136. doi:10.1055/s-0032-1331743

    Article  CAS  Google Scholar 

  28. Donatini G, Caiazzo R, Do Cao C, et al. (2014) Long-term survival after adrenalectomy for stage I/II adrenocortical carcinoma (ACC): a retrospective comparative cohort study of laparoscopic versus open approach. Ann Surg Oncol 21:284–291. doi:10.1245/s10434-013-3164-6

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to C. Vanbrugghe.

Ethics declarations

The authors declare that they have no conflict of interest.

For this type of study, formal consent is not required.

This article does not contain any studies with human participants or animals performed by any of the authors.

No funding to declare.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vanbrugghe, C., Lowery, A.J., Golffier, C. et al. Adrenocortical carcinoma surgery—surgical extent and approach. Langenbecks Arch Surg 401, 991–997 (2016).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: