Regional adrenalectomy completed by prophylactic hyperthermic intraperitoneal chemotherapy reduces the incidence of local and peritoneal recurrence after curative surgery for adrenocortical carcinoma.

BACKGROUND

Local and peritoneal recurrence (L/PR) after curative surgery for adrenocortical carcinoma has a high incidence and negatively affects the clinical course of the disease. We retrospectively reviewed our database to investigate the role of regional surgery and prophylactic HIPEC on oncologic outcome.

METHODS

Fifty-eight patients with stage II and III adrenocortical carcinoma (ACC) who underwent curative surgery were grouped according to the therapeutic approach: 11 received regional adrenalectomy and HIPEC (REGHIPEC), 18 underwent regional adrenalectomy (REGIONAL), and 29 had simple adrenalectomy (SIMPLE). The primary outcome was local/peritoneal disease-free survival (L/PDFS); secondary outcomes included overall disease-free survival (ODFS) and disease-specific survival (DSS).

RESULTS

HIPEC increased surgery duration by 80 minutes and hospital stay by 3 days. Major morbidity was 27.2% in the REGHIPEC group and 5.5% in the REGIONAL group. Median post-operative follow-up was 56 months for the entire cohort. L/PR was observed in 0%, 35%, and 82% of cases in the study groups, respectively. REGHIPEC and REGIONAL groups did not reach the median L/PDFS, while the SIMPLE group had a median L/PDFS of 23 months (P < .001). Overall recurrence (including hematogenous metastases) was observed in 18%, 50%, and 86.2% of cases, respectively (P < .001). Disease-specific mortality during follow-up was 18%, 33%, and 72.4% in the three groups, respectively. REGHIPEC and REGIONAL groups did not reach the median DSS, while the SIMPLE group had a median DSS of 63 months (P = .014).

CONCLUSION

HIPEC after regional adrenalectomy has decreases the incidence of local and peritoneal recurrence. If confirmed, this therapeutic strategy may change the surgical approach to stage II-III ACC.