Primary carcinoma of the adrenal cortex: An institutional surgical perspective

Background During the decades 1960 to 1980, we surgically treated 62 patients with primary adrenocortical carcinoma (ACC). In that study, operative mortality was 9.7% and the 5-year Kaplan-Meier survival 19%. In the decade 1981 to 1990, we have treated 31 patients with ACC. Methods A retrospective review of these more recent patients was undertaken in an attempt to answer 3 questions: Has: 1) the operative mortality been reduced? 2) the distribution of stages changed at operation? and 3) adjuvant therapy with mitotane (OPDD) been beneficial? 14 men and 17 women with a mean age of 51 years were retrospectively studied. 16 patients (52%) were placed on postoperative mitotane in a nonrandomized fashion with no difference in the distribution of stages between those patients receiving and those not receiving mitotane. Results Operative mortality was 9.7%. More patients in the current study had stage II disease (52 versus 32%) and fewer patients stage IV disease (35 versus 53%) at operation. 5-year Kaplan-Meier survival was 39%. 18 patients died more than 30 days following operation secondary to metastatic ACC, and 5 of the 10 patients currently living have metastatic disease. There was no statistically significant difference in the overall survival of the group treated versus the group not treated with mitotane (p=0.55), nor in the survival of treated versus non-treated stage II patients (p=0.16). Conclusions Although survival in the more recent study has improved, ACC remains a lethal disease. Operative mortality remains high with a large number of patients being operated upon with stage IV disease. The earlier promise of benefits from adjuvant therapy with mitotane are not substantiated.