IS SURGICAL RESECTION JUSTIFIED IN MALIGN ANT CORTICO-ADRENAL TUMORS WITH INFERIOR VENA-CAVA EXTENSION

Between January 1989 and December 1996, 6 patients (4 females and 2 ma les), ranging in age from 23 to 82, underwent surgery for malignant ad renocortical tumors with inferior vena cava extension. There were 5 ad renocortical carcinomas and 1 metastasis from a differentiated thyroid carcinoma. The tumor size ranges from 9 to 17 cm. 5 tumors involved h e right adrenal and 1 involved the left adrenal. Four patients had a v ena caval thrombus, extending into the right atrium in one case. Two p atients had direct tumoral invasion of the IVC wall without thrombius. All patients underwent en bloc excision of the adrenal gland and regi onal nodes, with nephrectomy in 4 cases and right hepatectomy in one c ase. Thrombectomy was performed in 4 cases with cardio-pulmonary by-pa ss in one case. Venous invasion without thrombus required total resect ion of the infra-hepatic IVC ine one case and vascular reconstruction with prosthetic patch in another case. There were no peri-operative de aths. Two patients died from metastatic disease after 13 and 40 months respectively. Four patients were alive with a follow-up ranging from 3 to 31 months, 3 patient were free of disease. Surgical resection of adrenocortical carcinomas with IVC extension can be attempted. There i s no increase in morbidity and mortality in comparison with surgical t reatment of other adrenal carcinomas. In these particular cases, the r isk of metastases and local recurrence is high, but long-term survival can be obtained after radical macroscopic resection.