Specific Postoperative Care

Not uncommonly, within hours after surgery, patients may exhibit hemodynamic manifestations of septic shock with negative blood cultures. This may be due to release of TNF and TNF-like or other factors during tumor manipulation. Symptomatic treatment is effective. Initially, stress doses and then maintenance doses of hydrocortisone are mandatory for patients with secretory tumors and for patients treated preoperatively with mitotane and ketoconazole. Drains are removed after the resumption of food intake to decrease the chance of a problematic chylous fistula.

7 8 9 10 years

FIGURE 69-4. Survival curves of patients overall and of patients with complete and incomplete resections. (From Icard P, Chapuis Y, Andreassian B, et al. Adrenocortical carcinoma in surgically treated patients: A retrospective study on 156 cases by the French Association of Endocrine Surgery. Surgery 1992;! 12:972.)

rate for patients undergoing an incomplete resection was 9% at 1 year.1

Tumor stage was the most important factor predicting prognosis, with a 5-year actuarial survival of 53% for locally invasive carcinomas (stage I, 33% and stage n, 55%). The survival rate was 24% in patients with stage III disease and 0% in patients with stage IV disease (Fig. 69-5).1,4,17

The patients who were younger than 35 years with nonfunctioning tumors or with tumors that secreted androgen had slightly better survival. Gender, tumor size, associated nephrectomy, and cellular lymphadenectomy had no impact on survival.1,12,17

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