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Adrenocortical carcinoma (ACC) is a rare cancer with a generally poor prognosis. In approximately 60% of cases the initial clinical manifestations are due to hypersecretion of adrenocortical hormones. Cushing's syndrome is the most frequent hormonal manifestation. In the remainder of the cases the tumor is identified after imaging procedures for nonspecific complaints such as abdominal pain and nausea. Medical therapy is employed in patients with unresectable or partially resected tumor and metastatic disease. The current accepted treatment is a combination of Mitotane with chemotherapy, aimed at controlling hormonal hypersecretion and reduction of tumor mass. In ACC patients there is wide variability in the course of the disease: some with metastatic disease will survive for more than 10 years, others succumb to the disease within months.

Constant advances and increasing experience in laparoscopic surgery renders it applicable for adrenal surgery. The wide exposure required for open adrenal surgery makes this minimally invasive procedure an attractive and advantageous alternative. Between 1996-1999, we performed 35 laparoscopic adrenalectomies in 30 patients 20-72-years old. Indications included: Conn's syndrome--14, pheochromocytoma--11, Cushing's syndrome--6, nonfunctioning adenoma--3, and metastatic sarcoma--1. 5 underwent bilateral laparoscopic adrenalectomy. In 3 (8.5%) the procedures were converted to open operations. Overall morbidity was 13% and there was no mortality. Mean operative time was 188 minutes, but only 130 in our last 10 cases. Mean hospital stay was 4 days and they returned to normal activity an average of 2 weeks later. According to our study and previous reports, laparoscopic adrenalectomy is feasible and safe and it may soon become the procedure of choice for adrenal tumors.