Store metastaser bør så vidt muligt fjernes kirurgisk, inden mitotanbehandlingen startes for at minimere risikoen for infarkt og blødning i tumoren grundet en hurtig cytotoksisk virkning af mitotan.
Large metastatic masses should be surgically removed as far as possible before starting mitotane treatment, in order to minimise the risk of infarction and haemorrhage in the tumour due to a rapid cytotoxic effect of mitotane.