Abstract：Objective: To evaluate the therapeutic effect of surgery on primary adrenocortical carcinoma and improve the diagnosis and treatment of adrenocortical carcinoma. Methods: A retrospective analysis of 27 patients with adrenocortical carcinoma who received surgical treatment in our department from January 1996 to June 2013 was performed. Patients' demographics, tumor characteristics, perioperative data, follow-up and prognostic information were collected. Results: Of the 27 patients, 17 patients received the open adrenalectomy and the rest 10 patients received the laproscopic surgery. The open adrenalectomy was done successfully. One case receiving retroperitoneal laparoscopic adrenalectomy was converted to open operation due to extensive adhesion between tumor and right lobe of liver, and the remaining cases obtained successful operations. The pathological examination showed that there was one case of stage 1, 8 cases of stage 2, 14 cases of stage 3 and 4 cases of stage 4. The retroperitoneal laparoscopic adrenalectomy had great advantages over open adrenalectomy in terms of operative time, estimated blood loss, perioperative blood transfusion rate, classification of postoperative complications and postoperative hospital stay. The patients were followed up for 22-104 months with the mean survival time of 33.1 months and the recurrence rate of 44.4%. Conclusions: Primary adrenocortical carcinoma is a rare type of adrenal tumor with high degree of malignancy and poor prognosis. The main treatment is the surgical therapy, in which the retroperitoneal laparoscopic adrenalectomy was characterized by shorter operation time, less bleeding, less trauma and quicker recovery. For seasoned surgeon, the larger size and advanced stage adrenocortical carcinoma performed by retroperitoneal laparoscopic adrenalectomy is still worth considering.
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