Metastases of Renal Cell Carcinoma to the Contralateral Adrenal Gland Managed by Laparoscopic Adrenalectomy

Abstract

Renal cell carcinoma (RCC) is the most lethal urological cancer. It is estimated that one thirds of the patients with localized cancer will develop distant metastasis after radical treatment. Adrenal metastasis of RCC are relatively rare and can be either synchronous or metachronous; ipsilateral, contralateral or bilateral; solitary or part of a massive metastatic spread. Contralateral adrenal metastasis are uncommon. It is well-known that some patients with isolated metastasis may benefit from surgical treatment. However, the optimal diagnosis and treatment of the contralateral adrenal metastasis from RCC has not yet been well defined. Since it was first described, laparoscopic adrenalectomy has become the gold standard for the surgical treatment of most adrenal conditions. The benefits of a minimally invasive approach to adrenal resection such as decreased hospital stay, shorter recovery time, and improved patient satisfaction are widely accepted. We report our experience with laparoscopic management of contralateral, metachronous adrenal metastases from RCC. Patients undergoing radical/partial nephrectomy for RCC were prospectively followed and evaluated regularly for general health status, local recurrence of tumor, and distant metastases. Patients identified to have had adrenal lesion/mass during the follow-up period were evaluated in detail both with imaging as well as endocrinal evaluation for assessment of functional status of these lesions. All these patients underwent laparoscopic adrenalectomy under general anesthesia. During the study period Jan 2006–Dec 2015, 8 patients (7 male and 1 female) with a mean age of 57.8 years underwent laparoscopic adrenalectomy. The mean operating time was 111.2 ± 32.5 min, blood loss was 45 ± 8.6 cm³ and postoperative stay was 37.5 ± 9.3 h. None of the patients had any major complications both early and delayed. The overall survival was 44.62 months. Metachronous, solitary, and contralateral adrenal metastasis from RCC is an extremely rare clinical complication that can occur very late after the radical/partial nephrectomy. Increased use of imaging modalities has led to more efficient and early detection of these lesions. Aggressive surgery remains the treatment of choice in these cases. Laparoscopic adrenalectomy remains a good, safe option with minimal morbidity and short hospital stay.