Multivisceral Resection for Suspected Adrenocortical Carcinoma

<b>Background</b>: Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy. Complete tumor resection (R0) is critical for prognosis and may require multivisceral resection in locally advanced cases. However, data on outcomes after multivisceral resection for ACC remain limited. This study evaluates the perioperative and oncologic outcomes of patients undergoing multivisceral resection for suspected ACC. <b>Methods</b>: We retrospectively analyzed 21 patients who underwent multivisceral resection with curative intent for suspected ACC. Three were later diagnosed with other tumor entities (sarcoma, non-small cell lung carcinoma metastasis and ganglioneuroma). The remaining 18 patients with histologically confirmed ACC were compared with 19 patients who underwent isolated adrenalectomy during the same study period. <b>Results</b>: Patients undergoing multivisceral resection were significantly younger (<i>p</i> = 0.003), had larger (<i>p</i> < 0.001) and more advanced tumors according to ENSAT classification (<i>p</i> < 0.001). All but one had open surgery; laparoscopic or hybrid approaches were more common in the isolated adrenalectomy group. Multivisceral resections were associated with longer operative times (<i>p</i> = 0.002), all required an ICU admission (<i>p</i> < 0.001), and had longer hospital stays (<i>p</i> = 0.001). Lymphnode metastases were observed only in the multivisceral group (<i>p</i> = 0.002). No significant differences were found in complication rates (<i>p</i> = 0.081), resection status (<i>p</i> = 0.091), progression-free survival (<i>p</i> = 0.095), or overall survival (<i>p</i> = 0.71). <b>Conclusions</b>: Multivisceral resection is a safe and feasible approach in specialized centers and may achieve comparable oncologic outcomes to isolated adrenalectomy, even in patients with more advanced disease. It should be considered when R0 resection is required and technically achievable.