Localized Disease Management

ACC overview

Localized ACC management is best organized around curative-intent surgical principles, the open-versus-minimally-invasive question, margin and nodal strategy, and the management of locally advanced or venous disease.¹²³

Clinical Map

Principles of ACC Resection

These papers emphasize complete en bloc resection, capsule preservation, and referral to experienced surgeons as the core determinants of curative-intent surgery.¹²³

Grouped note: Principles of ACC Resection

Minimally Invasive Surgery and Selection in ACC

This cluster covers the controversial literature on laparoscopic or retroperitoneoscopic adrenalectomy and the narrow group of patients in whom MIS may be acceptable.¹²³

Grouped note: Minimally Invasive Surgery and Selection in ACC

Margin Control and Extended Resection in ACC

These studies focus on margin status, lymphadenectomy, multivisceral resection, and the operative consequences of local organ invasion.¹²³

Grouped note: Margin Control and Extended Resection in ACC

Venous Extension and Complex Local Surgery in ACC

This note groups surgery for renal vein, IVC, or atrial extension and other anatomically complex but potentially resectable presentations.¹²³

Grouped note: Venous Extension and Complex Local Surgery in ACC

How to Read This Literature

The grouped notes below separate general resection principles from the technically complex literature on approach selection and en bloc surgery.¹²³

See Also

• staging_and_prognostic_stratification
• management_of_recurrent_disease
• adjuvant_therapy

References

Footnotes

1. European Society of Endocrine Surgeons (ESES) and European Network for the Study of Adrenal Tumours (ENSAT) recommendations for the surgical management of adrenocortical carcinoma. Br J Surg. 2017. PMID: 28199015. Local full text: 28199015.md ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶

2. Adrenocortical carcinoma: a practical guide for clinicians. Lancet Diabetes Endocrinol. 2025. PMID: 40086465. Local full text: 40086465.md ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶

3. Minimally Invasive Resection of Adrenocortical Carcinoma: A Multi-Institutional Study of 201 Patients. Ann Surg Oncol. 2016. PMID: 27770290. Local full text: 27770290.md ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶