Treatment and management of adrenal cancer in a specialized Australian endocrine surgical unit: approaches, outcomes and lessons learnt

Background Adrenocortical carcinoma is a rare and heterogeneous malignancy with poor outcomes. Recent research has suggested that outcomes may be improved by centralization of care in specialist centres. We review our evolving 21‐year experience in managing adrenocortical carcinoma with a view towards outcomes and lessons learnt. Methods A retrospective study of patients treated in our specialist endocrine surgical unit over 21 years was undertaken. Results Thirty‐five patients were treated from diagnosis, 29 forming a primary study cohort. Additionally, seven patients were referred to us for quaternary care, forming a secondary study cohort. The European Network for the Study of Adrenal Tumours (ENSAT) stage and immunohistochemical marker Ki‐67 index were strong prognostic indicators for survival. Conclusions Early stage, complete resection and Ki‐67