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We review our evolving 21\u2010year experience in managing adrenocortical carcinoma with a view towards outcomes and lessons learnt.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective study of patients treated in our specialist endocrine surgical unit over 21\u2009years was undertaken.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010five 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\u201067 index were strong prognostic indicators for survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Early stage, complete resection and Ki\u201067\u2009&lt;10% are the best prognosticators for survival. Aggressive surgical resection at index operation and of recurrent oligometastatic disease along with multimodal adjuvant treatment has led to long\u2010term survivors of patients with Stage 4 disease in our aggregate cohort.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.15032","type":"journal-article","created":{"date-parts":[[2019,2,2]],"date-time":"2019-02-02T07:53:01Z","timestamp":1549093981000},"page":"48-52","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Treatment and management of adrenal cancer in a specialized Australian endocrine surgical unit: approaches, outcomes and lessons learnt"],"prefix":"10.1111","volume":"89","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0646-7432","authenticated-orcid":false,"given":"Grace T. 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