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We evaluated oncological outcomes and complications rate in S-III patients who underwent extended resection in comparison with stage I\/II (S-I\/II). Among 1098 adrenalectomies over 27\u00a0years (1997 \u20132024) in a tertiary referral center, medical records of ACC patients were reviewed, excluding stage IV and not-multivisceral resections in S-III patients. Forty-eight patients met the inclusion criteria: 6 S-I (12.5%), 36 S-II (75%) and 6 S-III (12.5%) patients. The latter patients\u2019 cohort underwent multivisceral\n                    <jats:italic>en bloc<\/jats:italic>\n                    resections (3 total nephrectomies, one renal vein thrombectomy, one splenopancreasectomy associated with total nephrectomy, left hemicolectomy and omentectomy, one liver S6-S7-S8 resection). Open adrenalectomy was scheduled in all S-III patients. Minimally-invasive approach was scheduled in 21 (50%) S-I\/II patients. Conversion to open adrenalectomy was registered in 5 out these 21 patients. Locoregional and distant disease recurrences were registered in 19% of S-I\/II vs 33.3% of S-III patients and 28.6% of S-I\/II vs 66.7% of S-III patients, respectively (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.420,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.064). Postoperative complications were observed in 21.4% of S-I\/II patients and 16.7% of S-III patients (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.788). Kaplan\u2013Meier DFS and OS curves were comparable among the two groups (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.255,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.459, respectively). After univariable analysis, hyperfunction and chemotherapy were significantly associated with locoregional disease recurrence (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.02,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.04, respectively). OS and DFS of S-III ACC patients undergoing extended\n                    <jats:italic>en bloc<\/jats:italic>\n                    R0 resections were comparable to those of S-I\/II patients, without increased postoperative morbidity.\n                  <\/jats:p>","DOI":"10.1007\/s13304-025-02215-z","type":"journal-article","created":{"date-parts":[[2025,5,3]],"date-time":"2025-05-03T03:21:17Z","timestamp":1746242477000},"page":"307-317","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of en bloc extended R0 resections on oncological outcome of locally advanced adrenocortical carcinoma"],"prefix":"10.1007","volume":"78","author":[{"given":"Priscilla Francesca","family":"Procopio","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0865-700X","authenticated-orcid":false,"given":"Francesco","family":"Pennestr\u00ec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Laurino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther Diana","family":"Rossi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Schinzari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo","family":"Pontecorvi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmela","family":"De Crea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Raffaelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,3]]},"reference":[{"key":"2215_CR1","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1210\/er.2013-1029","volume":"35","author":"T Else","year":"2014","unstructured":"Else T, Kim AC, Sabolch A et al (2014) Adrenocortical carcinoma. 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Priscilla Francesca Procopio, Francesco Pennestr\u00ec and Antonio Laurino have a consultant agreement with Medtronic. Carmela De Crea, Esther Diana Rossi, Giovanni Schinzari and Alfredo Pontecorvi declare that they have no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"This article does not contain any studies with animals performed by any of the authors.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Research involving human participants and\/or animals"}},{"value":"Informed consent was obtained from all individual participants for whom identifying information is included in this article.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}