[Resection of a voluminous malignant tumor of the adrenal cortex by a combined thoraco-abdominal approach. Excellent survival over 5 years (author's transl)].

The case of a 41 year-old female presenting a voluminous (2 kg) non-functioning tumor of the adrenal cortex with excellent survival at 5 years and 3 months is reported. The tumor extended mainly cephalad and occupied the cerebral right hepatic space. The importance of preoperative inferior cavogram as well as a large thoraco-abdominal approach is stressed. The key to success is exposure and control of the entire segment of the inferior vena cava between renal vein and diaphragm. Particular attention must be paid to the middle (principal) suprarenal vein, a very short vessel (less than or equal to 1 cm) on the right side, which may enter either the inferior vena cava on the right suprahepatic vein.