Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Urol Int 2007;78:46–49 DOI: 10.1159/000096934 Open Surgical Treatment of Right-Sided Adrenal Carcinomas 1 15 cm Ubirajara Ferreira Renato Nardi Pedro Wagner Eduardo Matheus Alessandro Prudente Gustavo Mendonça Borges Nelson Rodrigues Netto Jr. Division of Uro-Oncology, Department of Urology, Hospital de Clínicas de Campinas, State University of Campinas, UNICAMP, Campinas, Brazil tal extended incision can accomplish broad exposure, if ar- ticulated costal retractors are available (used in liver trans- plantation), otherwise a thoracoabdominal incision is the best option. The most important feature of surgery is to ac- complish an efficient hemostasis of the liver parenchyma. Suture and stitches are not suitable for minor vascular struc- tures, and electrocauterization sometimes promotes hepat- ic lesions and does not provide bleeding control. Thus, the need for special hemostatic means is real, and they should be avaiable in these situations. Copyright © 2007 S. Karger AG, Basel Introduction Adrenal carcinomas are rare and are associated with a very poor prognosis. The incidence is estimated to be 1 in 1.7 million which represents 0.02% of all cancers and 0.2% of all cancer-related mortality. At the time of the diagnosis, hematogenic dissemination or local invasion can be detected in a significant proportion of the patients. The 5-year survival rate is 38% [1]. The etiology is not yet clearly defined [2]. Metastases are most commonly seen in lungs (60%), liver (50%), lymph nodes (48%), and bone (24%) [3] . Fur- ther, these tumors are prone to invade surrounding or- gans such as liver, kidney, spleen, and vena cava. Treat- Key Words Adrenal carcinomas 1 15 cm  Open surgical treatment, adrenal carcinomas  Right-sided ‘giant’ adrenal tumors Abstract Introduction: Adrenal carcinomas are rare and are associ- ated with a very poor prognosis. The incidence is estimated to be 1 in 1.7 million which represents 0.02% of all cancers and 0.2% of all cancer mortality. The 5-year survival rate is 38%. The purpose of this paper is to present a single-institu- tion experience in excising right-sided giant adrenal carcino- mas, discussing the difficulties and the usage of special sur- gical devices to facilitate the procedure. Patients and Methods: During June 2001 to June 2003, 18 patients with right-sided adrenal tumors were treated at the State Univer- sity of Campinas Hospital – UNICAMP. 4 out of the 18 patients presented lesions 1 15 cm, representing the study group. The mean age was 37 (range 26–65) years, 3 patients were young- er than 35 years, and 2 patients were men. A right-sided ex- tended subcostal incision was the surgical access in 1 patient (case 1) and a right-sided thoracoabdominal incision in the other 3 patients. Results: Adrenal cortical carcinoma was the histological diagnosis according to the Weiss criteria; no pos- itive surgical margin was detected, even in those patients with invasion of the hepatic capsule. The median follow-up period was 15 (range 6–30) months. Conclusions: A subcos- Received: November 10, 2005 Revised and accepted: May 5, 2006 Internationalis Urologia Dr. Renato Nardi Pedro Leontina C. Siqueira 62 Jardim Palmeiras 13098–330 Campinas, SP (Brazil) Tel. +55 211 996 076 773, Fax +55 213 788 7481, E-Mail rnpedro@gmail.com © 2007 S. Karger AG, Basel 0042–1138/07/0781–0046$23.50/0 Accessible online at: www.karger.com/uin