Case Report: Peritoneal disease from adrenal cortical carcinoma with hepatic metastases managed with cytoreductive surgery and multiple HIPEC sessions, resulting in survival beyond 13 years

Adrenocortical carcinoma (ACC) is a rare and highly aggressive malignancy with limited therapeutic options and poor long-term survival, particularly in advanced stages. Complete surgical resection remains the cornerstone of treatment, although recurrence is common and management of metastatic disease is challenging. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has shown survival benefits in other intraperitoneal malignancies, but its role in ACC remains uncertain due to the rarity of the disease and the scarcity of evidence. We present the case of a 46-year-old woman diagnosed with left-sided ACC in 2012, initially treated with laparoscopic adrenalectomy and adjuvant radiotherapy. Over the following years, she developed multiple peritoneal and hepatic recurrences, managed with repeated cytoreductive surgeries and systemic therapies, including mitotane-based chemotherapy. From 2014 to 2025, the patient underwent four cytoreductive surgeries combined with HIPEC using different intraperitoneal chemotherapy agents, including cisplatin, doxorubicin, and mitomycin C, each achieving complete cytoreduction. The intervals between procedures reached up to three years of disease-free survival, and the patient tolerated all treatments with minimal morbidity. Thirteen years after the initial diagnosis, she remains alive and functionally well following her most recent cytoreductive surgery and HIPEC for bladder and ileocecal recurrence. This case highlights the potential role of iterative cytoreductive surgery combined with HIPEC in achieving long-term survival and disease control in selected patients with recurrent or metastatic ACC. Although limited evidence precludes definitive conclusions, our findings suggest that the integration of HIPEC with surgical management may represent a valuable therapeutic option warranting further investigation in this rare and aggressive malignancy.