Background. Surgical resection is the only potentially curative treatm
ent for adrenal cortical carcinoma, yet the value of extended resectio
n, palliative resection, and tumor DNA analysis remains unclear. Metho
ds. The records of 23 patients with adrenal cortical carcinoma who und
erwent primary surgical resection at our institution were retrospectiv
ely reviewed. Flow cytometric DNA analysis was performed on primary tu
mor tissue from 14 patients. Results. Sixteen of 23 patients underwent
complete resection. For these 16 patients the median follow-up was 43
months, the actuarial median survival was 46 months, and the actuaria
l 5-year survival rate was 46%. The seven patients who underwent incom
plete resection all died of disease with a median survival of 8.5 mont
hs. Isolated focal recurrence as the first site of failure occurred in
two patients. Only completeness of resection (p = 0.004) and stage at
presentation (p = 0.006) were significant prognostic indicators. None
of the following predicted a poor prognosis in patients who underwent
complete resection: (1) need for extended resection, (2) presence of
renal vein or inferior vena cava tumor thrombus, or (3) tumor aneuploi
dy (14 of 14 tumors were aneuploid). Conclusions. Long-term survival i
s possible in patients with adrenal cortical carcinoma if complete, ma
rgin-negative tumor resection can be achieved. Isolated local recurren
ce is uncommon after complete resection. Because adrenal cortical carc
inomas are consistently aneuploid, tumor DNA content is not a useful p
rognostic factor.