Hyperthermic Intraperitoneal Chemotherapy and Regional Adrenalectomy in the management of Stage II & III Adrenocortical Carcinoma.

Inclusion criteria:
1. Male and females ≥18 years of age
2. Patients with preoperative diagnosis of ACC ENS@T stage II or III
3. No previous treatments for ACC except for mitotane.
4. Multidisciplinary indication to upfront surgery
5. Women of child-bearing potential must have a negative serum or urine pregnancy test within 24 hours prior to the start of study;
6. Women must not be breastfeeding;
7. Willing and able to comply with clinic visits and study-related procedures;
8. Willing and able to provide informed consent signed by study patient or legally acceptable representative.

Exclusion criteria:
1. Exploratory procedures or procedure conducted not according to the technical guidelines for regional adrenalectomy;
2. If the histological diagnosis after surgery will indicate a tumor histotype other than ACC, the patient will be dropped from the study.
3. Diagnosis other than ACC at histological examination;
4. Patients with ENS@T stage I or IV tumors;
5. Patients with ad ECOG performance status >1;
6. Intercurrent clinical conditions, such as uncontrolled infections or heart failure, that prevent the surgical procedure from being performed
7. Patients with extensive inferior vena cava thrombosis requiring vascular replacement or extracorporeal circulation procedures;
8. Pregnancy;
9. Continued sexual activity in women of childbearing potential or sexually active men who are unwilling to practice highly effective contraception (including at least one highly effective contraception method, see study protocol) for at least 6 months after the HIPEC;
10. Refusal to sign the informed consent;