ROLE OF REOPERATION IN RECURRENCE OF ADRENAL-CORTICAL CARCINOMA - RESULTS FROM 188 CASES COLLECTED IN THE ITALIAN NATIONAL REGISTRY FOR ADRENAL-CORTICAL CARCINOMA

Background. Recurrence of adrenal cortical carcinoma (ACC) after radic al surgery is a common finding. Although successful reoperations have been reported with encouraging results, most published experiences are anecdotal and based on few cases. We report the results of surgical t reatment for recurrent ACC in a multiinstitutional series. Methods. On e hundred eighty-eight cases of ACC were collected in a national regis try. A complete follow-up was obtained in 179 cases. At initial diagno sis 92 patients had local disease (stage I or II). One hundred seventy patients underwent surgical treatment, considered radical in 140; in this group, recurrent disease was observed in 52 cases (37%) after a m ean disease-free interval of 21.7 months. Results. Adjuvant chemothera py was ineffective in ameliorating the prognosis. The mean survival in 20 patients who underwent reoperation was significantly higher (15.85 +/- 14.9 months) than in nonreoperated cases (3.2 +/- 2.9 months). Fi ve-year actuarial survival in reoperated patients is significantly bet ter than in nonreoperated patients (49.7% versus 8.3%, respectively). Conclusions. Although the prognosis of this tumor is still poor, surge ry is the only effective therapy; reoperation allows survival comparab le to that observed in patients without recurrent disease. An aggressi ve strategy for recurrent ACC is advisable until prospective studies d emonstrate a real effectiveness for chemotherapy.