A multidisciplinary approach for peritoneal carcinomatosis and bilobar liver metastases from colorectal cancer: case report and review of the literature.

BACKGROUND: Peritoneal carcinomatosis develops in 15% of patients with primary colorectal cancer (CRC) and in 25% of those with recurrence. Liver metastases are also frequent and appear at some time in 35-55% of patients with CRC. When both conditions are present and treated palliatively, the expected median survival is 5-6 months. Recent publications suggest survival is improved when R0 resection of both peritoneal and liver diseases is achieved. CASE PRESENTATION: A 36-year-old woman with synchronous peritoneal and liver metastases of colorectal origin was treated with a stepwise approach consisting of initial cytoreductive surgery, minor liver resection, intraperitoneal intraoperative hyperthermic chemotherapy, adjuvant chemotherapy, right portal embolization, and finally, right hepatectomy achieving an R0 resection. The patient is alive and free of disease after 30 months of follow-up. DISCUSSION: Patients with peritoneal carcinomatosis and liver metastases from CRC must be carefully evaluated by multidisciplinary oncological teams in order to offer the possibility of surgery to obtain an R0 resection in selected patients (especially if the peritoneal cancer index is <19 and there is resectable or potentially resectable metastatic liver disease).

Laparoscopic approach of primary bladder endometriosis.

OBJECTIVE: To report a case of primary bladder endometriosis treated with laparoscopic partial cystectomy. METHODS: We report the case of a 38 year old woman presenting with cyclic catamenial pain and hematuria who was diagnosed of bladder endometriosis by means of cystoscopy and MRI. Partial cystectomy using a laparoscopic approach was performed and symptoms disappeared. RESULTS: We report a well-documented case of primary bladder endometriosis and the laparoscopic approach used for its treatment. A review of the concept and the therapeutic alternatives are presented. CONCLUSIONS: Bladder endometriosis must be in mind when cyclic catamenial symptoms of pain and hematuria are present. When diagnosed, the laparoscopic approach must be considered the preferential option.

Abordaje laparoscópico de la endometrosis vesical primaria / Laparoscopic approach of primary bladder endometriosis

OBJETIVO: Presentar un caso de endometriosis vesical primaria tratada mediante cistectomía parcial por vía laparoscópica. MÉTODOS: Presentamos el caso de una mujer de 38 años que se diagnóstico por cistoscopia y RNM de endometriosis vesical a raíz de presentar clínica de dolor y hematuria cíclica catamenial. Se realizó una cistectomía parcial por vía laparoscópica que fue definitiva. RESULTADOS: Presentamos un caso bien documentado de endometriosis vesical primaria y su tratamiento por vía laparoscópica, así como una revisión conceptual y de las opciones terapéuticas. CONCLUSIONES: La endometriosis vesical debe tenerse en mente ante la clínica de dolor pélvico y hematuria con perfil catamenial. Cuando se diagnóstica, el abordaje laparoscópico debe plantearse como la opción preferente

OBJECTIVE: To report a case of primary bladder endometriosis treated with laparoscopic partial cystectomy. METHODS: We report the case of a 38 year old woman presenting with cyclic catamenial pain and hematuria who was diagnosed of bladder endometriosis by means of cystoscopy and MRI. Partial cystectomy using a laparoscopic approach was performed and symptoms disappeared. RESULTS: We report a well-documented case of primary bladder endometriosis and the laparoscopic approach used for its treatment. A review of the concept and the therapeutic alternatives are presented. CONCLUSIONS: Bladder endometriosis must be in mind when cyclic catamenial symptoms of pain and hematuria are present. When diagnosed, the laparoscopic approach must be considered the preferential option

Diverticulectomía y miotomía del cricofarígeo para el tratamiento del divertículo de Zenker. Presentación de una serie de 33 casos / Diverticulectomy and cricopharyngeal myotomy for the treatment of Zenker‘s diverticulum. a presentation of 33 cases

IntroducciónEl tratamiento clásico del divertículo de Zenker (DZ) ha sido la miotomía del cricofaríngeo (MCF), discutiéndose la necesidad o no de resecarlo (diverticulectomía versus diverticulopexia). Sin embargo, la evolución de las técnicas endoscópicas está obligando a replantear las estrategias de tratamiento. Analizamos las complicaciones y los resultados clínicos de nuestra serie con la miotomía del cricofaríngeo y diverticulectomía en pacientes con DZ.MétodoEstudio observacional retrospectivo y descriptivo de 33 pacientes a los que se realizó, entre enero de 1998 y diciembre de 2010, diverticulectomía y MCF en los hospitales universitarios Virgen del Rocío de Sevilla y Carlos Haya de Málaga. Se analiza la morbilidad y variables demográficas y operatorias que pueden asociarse con esta.ResultadosDiecisiete pacientes fueron tratados en el hospital Carlos Haya de Málaga y dieciséis en el hospital Virgen del Rocío de Sevilla. Aunque no hubo mortalidad, la tasa de morbilidad de la serie fue del 27% (9 casos), siempre relacionada con fístula esófago-cutánea. Ninguna de las variables estudiadas se asoció significativamente con la aparición de morbilidad. Tras un seguimiento medio de 44 meses (rango 6-192) ningún paciente ha presentado recidiva clínica ni radiológica del DZ.ConclusionesLa diverticulectomía asociada a MCF es una buena técnica para el tratamiento del DZ, con excelentes resultados clínicos y funcionales a medio y largo plazo, pese a que la morbilidad mayor en forma de fístula esófago-cutánea ha sido alta (AU)

IntroductionThe classic treatment of Zenker‘s diverticulum (ZD) has been cricopharyngeal myotomy (CPM), with the need or not to resect it being argued (diverticulectomy versus diverticulopexy). However, the advance of endoscopic techniques requires new treatment strategies to be established. We analyse the complications and clinical results of our series with cricopharyngeal myotomy and diverticulectomy in patients with ZD.MethodA retrospective, observational and descriptive study was conducted on 33 patients who, between January 1998 and December 2010, had a diverticulectomy and CPM performed in the university hospitals Virgen del Rocío in Seville and Carlos Haya in Malaga. Demographic and operative variables that might be associated with morbidity were analyzed.ResultsSeventeen patients were treated in the Carlos Haya Hospital, Málaga and sixteen in the Virgen del Rocío Hospital, Seville. Although there were no deaths, the morbidity rate of the series was 27% (9 cases), all associated with an oesophageal-cutaneous fistula. None of the variables studied were significantly associated with the appearance of morbidity. None of the patients had a clinical or radiological recurrence of ZD after a mean follow up of 44 months (range, 6 -192).ConclusionsDiverticulectomy combined with CPM is a good technique for the treatment of ZD, with excellent clinical and functional results in the medium to long term, despite the high morbidity in the form of an oesophageal-cutaneous fistula (AU)

[Diverticulectomy and cricopharyngeal myotomy for the treatment of Zenker's diverticulum. a presentation of 33 cases]. / Diverticulectomía y miotomía del cricofarígeo para el tratamiento del divertículo de Zenker. Presentación de una serie de 33 casos.

INTRODUCTION: The classic treatment of Zenker's diverticulum (ZD) has been cricopharyngeal myotomy (CPM), with the need or not to resect it being argued (diverticulectomy versus diverticulopexy). However, the advance of endoscopic techniques requires new treatment strategies to be established. We analyse the complications and clinical results of our series with cricopharyngeal myotomy and diverticulectomy in patients with ZD. METHOD: A retrospective, observational and descriptive study was conducted on 33 patients who, between January 1998 and December 2010, had a diverticulectomy and CPM performed in the university hospitals Virgen del Rocío in Seville and Carlos Haya in Malaga. Demographic and operative variables that might be associated with morbidity were analyzed. RESULTS: Seventeen patients were treated in the Carlos Haya Hospital, Málaga and sixteen in the Virgen del Rocío Hospital, Seville. Although there were no deaths, the morbidity rate of the series was 27% (9 cases), all associated with an oesophageal-cutaneous fistula. None of the variables studied were significantly associated with the appearance of morbidity. None of the patients had a clinical or radiological recurrence of ZD after a mean follow up of 44 months (range, 6 -192). CONCLUSIONS: Diverticulectomy combined with CPM is a good technique for the treatment of ZD, with excellent clinical and functional results in the medium to long term, despite the high morbidity in the form of an oesophageal-cutaneous fistula.

Trasplante hepático en tumor carcinoide de páncreas metastático / Liver transplantation for pancreatic carcinoid tumor with metastasis

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Outpatient laparoscopic adrenalectomy: a new step ahead.

BACKGROUND: The feasibility of performing laparoscopic adrenalectomy (LA) as an outpatient procedure in selected patients in the context of a specialized unit has been assessed in this study. METHODS: Retrospective cohort of 22 patients who underwent LA without hospital admission under strict selection criteria within a specific laparoscopic surgery unit of a tertiary hospital center has been reported. Patient demographics, indications for surgery, operative data, outpatient management, morbidity, and immediate follow-up have been analyzed. RESULTS: The mean age of the patients was 50.9 years (median 52.5, range 28-65) and 13 (59.1%) were women. All patients underwent successful LA and none of them required conversion to laparotomy. The mean length of the procedure was 56.6 min (median 60, range 15-120 min) and no patient required transfusion. The most common indications for surgery were adrenal incidentaloma and primary hyperaldosteronism (36.4% each). Three patients accurately complied with the MAS regimen and the other 19 spent the night on a DC basis and were discharged with the hospital stay being less than 23 h. No patient required readmission and relevant events occurred only in three patients. With regard to postoperative pain management, only six patients (27.27%) required more than 1 week of analgesics. In 68.1% of the cases, resuming physical and professional activity took less than 2 weeks and only three patients required more than 1 month before restoring a "normal life." CONCLUSION: By applying strict protocol and selection criteria, LA can be safely and successfully performed as an outpatient procedure within an experienced laparoscopic unit.

Tratamiento agresivo de las complicaciones arteriales del trasplante hepático. Impacto sobre la supervivencia y las complicaciones biliares / Aggressive management of the arterial complications of liver transplantation. Impact upon survival and biliary complications

Se estudian las complicaciones arteriales (CA) ocurridas en 400 trasplantes realizados entre 1997 y 2006. Se dividen en 2 grupos según el tipo de tratamiento realizado: grupo i: tratamiento invasivo (tratamiento sobre la arteria o retrasplante), y grupo ii: tratamiento conservador o sintomático. Se analizan el impacto del tratamiento sobre la supervivencia y las complicaciones biliares (CB).Resultados Se han presentado 18 CA (4,5%), 10 complicaciones precoces (7 trombosis y 3 estenosis) y 8 complicaciones tardías (5 trombosis y 3 estenosis). El 90% de las complicaciones precoces se trató de forma invasiva (4 trombectomías urgentes, un retrasplante, 3 angioplastias y una ligadura de arteria hepática), y el 25% de las complicaciones tardías se trató con retrasplante (3); el 75% restante recibió tratamiento sintomático. Resultados La supervivencia a 12 y 60 meses fue inferior en el grupo ii (el 57 y el 42%) que en el grupo i (el 90 y el 68%), aunque sin alcanzar significación estadística. La tasa global de CB de enfermos con trombosis arterial fue del 50%. En el grupo i del %, significativamente menor que el grupo ii con el 71% (p<0,04).Conclusiones El tratamiento invasivo de las CA en el trasplante hepático se asocia a una mayor supervivencia a corto plazo y reduce de forma significativa la aparición de CB. En nuestra experiencia, los pacientes se benefician de un diagnóstico precoz y un tratamiento intensivo en este tipo de complicaciones (AU)

Abstract A study was made of the arterial complications documented in 400 transplants performed between 1997 and 2006. The patients were divided into two groups according to the type of treatment provided. Group I: invasive management (arterial treatment or re-transplant), and Group II: conservative or symptomatic management. The impact of management upon survival and biliary complications was analysed. Results There were 18 arterial complications (4.5%): 10 early (7 thromboses and 3 stenoses) and 8 late (5 thromboses and 3 stenoses). Ninety percent of the early complications were subjected to invasive management (4 emergency thrombectomies, 1 re-transplant and 3 angioplasties), while 25% of the late complications were treated in the form of re-transplant and the remaining 75% were subjected to symptomatic treatment. Survival after 12 and 60 months was lower in Group II (57% and 42%) than in Group I (90% and 68%), although without reaching statistical significance. The overall biliary complications rate among the patients with arterial thrombosis was 50%. The rate was significantly lower in Group I than in Group II (10% versus 71%) (P<04).Conclusions Invasive management of the arterial complications of liver transplantation is associated with longer short-term survival and significantly fewer biliary complications. In our experience, patients benefit from an early diagnosis and aggressive management of complications of this kind (AU)

[Development and evolution of laparoscopic adrenalectomy in an specialized team: from the beginning to the outpatient setting]. / Desarrollo y evolución de la suprarrenalectomía laparoscópica en una unidad especializada: de los casos iniciales al hospital de día.

BACKGROUND: After the first reports in 1992, laparoscopic adrenalectomy (LA) has evolved technically until becoming the standard approach for the treatment of most of the adrenal gland diseases. MATERIAL AND METHODS: Retrospective and descriptive study of 67 patients who underwent 68 LA between January-1998 and December-2008 in the Laparoscopic Surgery Unit of the General and Digestive Surgery Service in a third level hospital (only one case of bilateral LA). The group was divided in 2 periods, P-1 (1998-2003, 22 cases) and P-2 (2004-2008, 45 cases), which have been compared to evaluate the evolution of the LA technique. RESULTS: Indications for LA were: 19 incidentalomas, 19 primary hyperaldosteronism, 18 pheocromocitoms, 5 cases of symptomatic and non-functioning adrenal masses, 4 Cushing adenomas and 2 metastases. There was no mortality, only 4 patients had minor complications (6%) and conversion rate was only 3% (2 cases). Mean size of adrenal glands resected was 3.83 cm and the mean operative time was 86 minutes. Mean postoperative hospital stay was 3 days and in P-2 seventeen patients were discharged on an outpatient basis (hospital stay less than 23 hours). CONCLUSIONS: In our experience, LA for the treatment of adrenal diseases has shown to be safe, effective and reproducible with low complications and excellent tolerance by patients. When the learning curve is overcome, hospital stay and operative time clearly decrease. As a consequence, LA can be planned in selected cases as outpatient surgery with good results.

[Aggressive management of the arterial complications of liver transplantation. Impact upon survival and biliary complications]. / Tratamiento agresivo de las complicaciones arteriales del trasplante hepático. Impacto sobre la supervivencia y las complicaciones biliares.

UNLABELLED: A study was made of the arterial complications documented in 400 transplants performed between 1997 and 2006. The patients were divided into two groups according to the type of treatment provided. Group I: invasive management (arterial treatment or re-transplant), and Group II: conservative or symptomatic management. The impact of management upon survival and biliary complications was analysed. RESULTS: There were 18 arterial complications (4.5%): 10 early (7 thromboses and 3 stenoses) and 8 late (5 thromboses and 3 stenoses). Ninety percent of the early complications were subjected to invasive management (4 emergency thrombectomies, 1 re-transplant and 3 angioplasties), while 25% of the late complications were treated in the form of re-transplant and the remaining 75% were subjected to symptomatic treatment. Survival after 12 and 60 months was lower in Group II (57% and 42%) than in Group I (90% and 68%), although without reaching statistical significance. The overall biliary complications rate among the patients with arterial thrombosis was 50%. The rate was significantly lower in Group I than in Group II (10% versus 71%) (P<04). CONCLUSIONS: Invasive management of the arterial complications of liver transplantation is associated with longer short-term survival and significantly fewer biliary complications. In our experience, patients benefit from an early diagnosis and aggressive management of complications of this kind.

Desarrollo y evolución de la suprarrenalectomía laparoscópica en una unidad especializada: de los casos iniciales al hospital de día / Development and evolution of laparoscopic adrenalectomy in an specialized team: from the beginning to the outpatient setting

Introducción: Desde su descripción inicial en 1992, la suprarrenalectomía laparoscópica (SL) ha evolucionado como técnica hasta convertirse en el abordaje estándar para el tratamiento de la patología quirúrgica adrenal.Material y métodos: Realizamos un estudio observacional descriptivo de 67 pacientes sometidos a 68 SL entre enero de 1998 y diciembre de 2008 en la unidad de cirugía laparoscópica del servicio de cirugía general y digestiva de un hospital de tercer nivel (sólo 1 caso de SL bilateral). Igualmente, la serie se ha dividido en dos periodos: P-1 (1998-2003, 22 casos) y P-2 (2004-2008, 45 casos), que se han comparado para valorar la evolución de la técnica.Resultados: Las indicaciones para la realización de SL fueron: 19 incidentalomas, 19 aldosteronomas, 18 feocromocitomas, 5 casos de masa adrenal no funcionante, 4 adenomas de Cushing y 2 metástasis. La mortalidad fue nula, sólo 4 pacientes presentaron complicaciones menores (6%) y la conversión sólo fue necesaria en 2 casos (3%). El tamaño medio glandular de nuestra serie fue de 3,83 cm y la duración media de la cirugía, 86 min. La estancia hospitalaria media fue de 3 días, y en el P-2 hasta 17 pacientes fueron dados de alta en régimen de cirugía mayor ambulatoria (menos de 23 h de estancia). Conclusiones: En nuestra serie, el abordaje laparoscópico para el tratamiento de la patología quirúrgica suprarrenal se ha demostrado seguro, efectivo, reproducible, con escasas complicaciones y muy bien tolerado por los pacientes. Cuando se supera la curva de aprendizaje, el tiempo quirúrgico y la estancia hospitalaria se reducen, lo cual permite, en casos seleccionados, plantear esta técnica en régimen de cirugía mayor ambulatoria (AU)

Background: After the first reports in 1992, laparoscopic adrenalectomy (LA) has evolved technically until becoming the standard approach for the treatment of most of the adrenal gland diseases.Material y methods: Retrospective and descriptive study of 67 patients who underwent 68 LA between January-1998 and December-2008 in the Laparoscopic Surgery Unit of the General and Digestive Surgery Service in a third level hospital (only one case of bilateral LA). The group was divided in 2 periods, P-1 (1998-2003, 22 cases) and P-2 (2004-2008, 45 cases), which have been compared to evaluate the evolution of the LA technique.Results: Indications for LA were: 19 incidentalomas, 19 primary hyperaldosteronism, 18 pheocromocitoms, 5 cases of symptomatic and non-functioning adrenal masses, 4 Cushing adenomas and 2 metastases. There was no mortality, only 4 patients had minor complications (6%) and conversion rate was only 3% (2 cases). Mean size of adrenal glands resected was 3,83 cm and the mean operative time was 86 minutes. Mean postoperative hospital stay was 3 days and in P-2 seventeen patients were discharged on an outpatient basis (hospital stay less than 23 hours).Conclusions: in our experience, LA for the treatment of adrenal diseases has shown to be safe, effective and reproducible with low complications and excellent tolerance by patients. When the learning curve is overcome, hospital stay and operative time clearly decrease. As a consequence, LA can be planned in selected cases as outpatient surgery with good results (AU)

Cytoreductive surgery and intraoperative intraperitoneal hyperthermic chemotherapy in patients with peritoneal carcinomatosis of colorectal origin.

The median survival in patients with peritoneal carcinomatosis from colorectal adenocarcinoma is,with conventional approaches, only about six months. Combined treatment consisting of maxi-mum cytoreductive surgery plus intraoperative intraperitoneal hyperthermic chemotherapy has been shown, albeit in small non-comparative series, to increase disease-free survival and overall survival, compared with previous series. Further, a randomized trial has demonstrated better results (a median survival of 22.4 months) with cytoreduction plus intraperitoneal chemotherapy compared with conventional chemotherapy. Technical considerations, infrastructure requirements and possible complications imply specialized centres and staff. Surgery consists of peritonectomy of affected areas and fulguration of all macroscopic lesions. Intraperitoneal chemotherapy must reach all parts of the peritoneal cavity and the temperature of the hyperthermic procedure must be maintained between 42-44 degrees C. Three prognostic factors associated with this procedure are: pathologic tumour grade, peritoneal carcinomatosis index, and cytoreductive surgery grade.

Cytoreductive surgery and intraoperative intraperitoneal hyperthermic chemotherapy in patients with peritoneal carcinomatosis of colorectal origin

The median survival in patients with peritoneal carcinomatosis from colorectal adenocarcinoma is, with conventional approaches, only about six months. Combined treatment consisting of maximum cytoreductive surgery plus intraoperative intraperitoneal hyperthermic chemotherapy has been shown, albeit in small non-comparative series, to increase disease-free survival and overall survival, compared with previous series. Further, a randomized trial has demonstrated better results (a median survival of 22.4 months) with cytoreduction plus intraperitoneal chemotherapy compared with conventional chemotherapy. Technical considerations, infrastructure requirements and possible complications imply specialized centres and staff. Surgery consists of peritonectomy of affected areas and fulguration of all macroscopic lesions. Intraperitoneal chemotherapy must reach all parts of the peritoneal cavity and the temperature of the hyperthermic procedure must be maintained between 42-44ºC. Three prognostic factors associated with this procedure are: pathologic tumour grade, peritoneal carcinomatosis index, and cytoreductive surgery grade

[Adrenal carcinoma: 7 year disease free survival after complete primary tumor resection and repeated resection of local-regional and distant recurrences. Review after one case with poor initial life expectancy]. / Carcinoma suprarrenal: supervivencia a 7 años libre de enfermedad tras resección completa del tumor primario y resecciones repetidas de recidivas locorregional y a distancia. Revisión a raiz de un caso con una pobre esperanza de vida inicial.

OBJECTIVES: We report the case of a female patient with adrenal carcinoma who had undergone surgery and presented with local-regional and distant recurrences, emphasizing the importance of the aggressive surgical treatment to achieve long-term survival which is unexpected sometimes. Currently, it represents the gold standard and all cases should be reported to stimulate other groups to work in this line. METHODS/RESULTS: We report the case of a 29-year-old female patient who consulted for left flank pain, being diagnosed of an adrenal tumor by radiological tests; she underwent surgical excision of a left adrenal carcinoma (stage II). Later on she presented with local-regional recurrences (2 times) and distant metastases (liver) undergoing excision in three procedures. Currently, the patient is alive and free of disease 7 years after diagnosis. CONCLUSIONS: Adrenal cancer recurrences have been considered lethal in the short-term. Nevertheless, an aggressive surgical approach of local recurrences and metastasic disease may significantly prolong patient's survival and, sometimes, leave the patient disease free several years after the diagnosis of the primary tumor.

Carcinoma suprarenal: supervivencia a 7 años libre de enfermedad tras resección completa del tumor primario y resecciones repetidas de recidivas locorregional y a distancia. Revisión a raíz de un caso con una pobre esperanza de vida inicial / Adrnal carcinoma: 7 year disease free survival after complete primary tumor resection and repeated resection of local-regional and distant recurrences. Review after one case with poor initial life expectancy

OBJETIVO: Comunicamos el caso de unapaciente con un cáncer suprarrenal intervenido que presentóposteriormente recidivas locorregional y a distancia,enfatizando la importancia del tratamiento quirúrgicoagresivo para lograr supervivencias a veces noesperadas a largo plazo. En la actualidad, representael “gold standard” y todos los casos deben comunicarsepara estimular a los distintos grupos a trabajar enesta línea.MÉTODO/RESULTADOS: se presenta el caso de unapaciente de 29 años que consultó por dolor en flancoizquierdo, diagnosticándose en los estudios de imagenun tumor suprarrenal; fue intervenida, realizándoseresección de un carcinoma suprarrenal izquierdo(Estadio II). Posteriormente presentó recidiva locorregional(en dos ocasiones) y a distancia (en hígado), siendoresecada la enfermedad en las tres ocasiones en sutotalidad. En el momento actual, 7 años después deldiagnóstico, está viva y libre de enfermedad.CONCLUSIÓN: la recidiva del cáncer suprarrenal seha considerado letal a corto plazo desde el punto devista pronóstico. Sin embargo, un abordaje quirúrgicoagresivo de la enfermedad recurrente y metastásicapuede prolongar de forma significativa la supervivenciadel paciente y lograr, en ocasiones, “status” de libre deenfermedad varios años después del diagnóstico deltumor primario

OBJECTIVES: We report the case of afemale patient with adrenal carcinoma who had undergonesurgery and presented with local-regional and distantrecurrences, emphasizing the importance of theaggressive surgical treatment to achieve long-term survivalwhich is unexpected sometimes. Currently, it representsthe gold standard and all cases should be reported tostimulate other groups to work in this line.METHODS/RESULTS: We report the case of a 29-yearoldfemale patient who consulted for left flank pain,being diagnosed of an adrenal tumor by radiologicaltests; she underwent surgical excision of a left adrenalcarcinoma (stage II). Later on she presented with localregionalrecurrences (2 times) and distant metastases(liver) undergoing excision in three procedures.Currently, the patient is alive and free of disease 7 yearsafter diagnosis.CONCLUSIONS: Adrenal cancer recurrences havebeen considered lethal in the short-term. Nevertheless,an aggressive surgical approach of local recurrencesand metastasic disease may significantly prolongpatient’s survival and, sometimes, leave the patient diseasefree several years after the diagnosis of the primarytumor