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.