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The survival benefit of adrenal surgery in patients with synchronous metastatic disease has not been well explored.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with ACC with synchronous metastases were identified from the Surveillance, Epidemiology, and End Results database (2010\u20132016). The effect of adrenal surgery on different patterns of distant metastases was assessed. The overall survival was estimated by the Kaplan\u2013Meier method. Multivariable Cox regression analysis was performed to identify prognostic factors associated with survival outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 202 patients with synchronous metastatic ACC were identified from the SEER database, 76 (37.6%) patients underwent adrenal surgery. Compared to nonsurgical patients, patients who underwent adrenal surgery had a better survival (median overall survival: 4 vs. 13\u00a0months, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). In sub\u2010analyses, except for patients with liver metastases (<jats:italic>P<\/jats:italic>\u2009=\u20090.670), adrenalectomy could consistently confer a significant survival benefit in patients with lung metastases (<jats:italic>P<\/jats:italic>\u2009=\u20090.003), bone metastases (<jats:italic>P<\/jats:italic>\u2009=\u20090.020), and multiple metastases (<jats:italic>P<\/jats:italic>\u2009=\u20090.002). Cox regression analysis revealed that in addition to adrenalectomy [hazard ratio (HR)\u2009=\u20090.64, 95% confidence interval (CI) 0.45\u20130.92; <jats:italic>P<\/jats:italic>\u2009=\u20090.017], metastasectomy (HR\u2009=\u20090.48, 95% CI 0.26\u20130.86; <jats:italic>P<\/jats:italic>\u2009=\u20090.013), and chemotherapy (HR\u2009=\u20090.59, 95% CI 0.42\u20130.82; <jats:italic>P<\/jats:italic>\u2009=\u20090.002) were also associated with improved survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our findings support the view that adrenal surgery may be associated with improved survival in patients with synchronous metastatic ACC (except for patients with liver metastases), and the metastatic sites have significant prognostic implications on survival outcomes with adrenal surgery.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-021-05957-0","type":"journal-article","created":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T16:07:55Z","timestamp":1611331675000},"page":"1457-1465","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Adrenal Surgery for Synchronously Metastatic Adrenocortical Carcinoma: A Population\u2010Based Analysis"],"prefix":"10.1002","volume":"45","author":[{"given":"Kan","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Urology, Institute of Urology, West China Hospital Sichuan University 37 Guoxue Lane 610041 Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihong","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Urology, Institute of Urology, West China Hospital Sichuan University 37 Guoxue Lane 610041 Chengdu Sichuan 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