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Laparoscopic adrenalectomy for adrenal metastases of solid tumors

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Abstract

Introduction

In patients with history of cancer adrenal metastases can be found in up to 70% of adrenal tumors detected during follow-up. Currently, laparoscopic adrenalectomy (LA) is considered the gold standard approach for benign adrenal tumors but is still controversial in malignant disease. Depending on the patient’s oncological status, adrenalectomy might be a possible treatment option. Our objective was to analyze the results of LA for adrenal metastasis from solid tumors in two referral centers.

Methods

Retrospective analysis of 17 patients with non-primary adrenal malignancy treated with LA between 2007 and 2019 was performed. Demographic and primary tumor data, type of metastasis, morbidity, disease recurrence and evolution were evaluated. Patients were compared according to type of metastases: synchronous (< 6 months) vs metachronous (≥ 6 months).

Results

17 patients were included. Median metastatic adrenal tumor size was 4 cm (IQR, 3–5.4). We had one conversion to open surgery. Recurrence was found in 6 patients with one recurring in the adrenal bed. The median OS was 24 (IQR, 10.5–60.5) months and 5-year OS was 61.4% (95%CI: 36.7%–81.4%). Patients with metachronous metastases had better overall survival vs. patients with synchronous metastases (87% vs. 14%, p = 0.0037).

Conclusion

LA for adrenal metastases is a procedure associated with low morbidity and acceptable oncologic outcomes. Based on our results, seems reasonable to offer this procedure to carefully selected patients, mainly those with metachronous presentation. Indication of LA must be done on a case by case evaluation in the context of a multidisciplinary tumor board.

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Abbreviations

LA:

Laparoscopic adrenalectomy

LOS:

Length of stay

DFS:

Disease-free survival

OS:

Overall survival

NSCLC:

Non-small cell lung cancer

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Authors and Affiliations

  1. Retroperitoneal, Pelvic and Adrenal Tumors Unit, Department of General Surgery, British Hospital of Buenos Aires, Perdriel 74, CABA, 1280AEB, Buenos Aires, Argentina

    Sergio D. Quildrian

  2. Retroperitoneal, Pelvic and Adrenal Tumors Unit, Department of General Surgery, British Hospital of Buenos Aires, Perdriel 74, CABA, 1280AEB, Buenos Aires, Argentina

    Walter S. Nardi

  3. Department of General Surgery, British Hospital of Buenos Aires, Perdriel 74, CABA, 1280AEB, Buenos Aires, Argentina

    Facundo Iriarte

  4. Department of Endocrinology, British Hospital of Buenos Aires, Perdriel 74, CABA, 1280AEB, Buenos Aires, Argentina

    Maricel Recalde

  5. Endocrinology Unit, Angel H. Roffo Institute of Oncology, University of Buenos Aires, Avenida San Martin 5481, CABA, C1417, Buenos Aires, Argentina

    Inés Califano

  6. Sarcoma and Melanoma Unit, Angel H. Roffo Institute of Oncology, University of Buenos Aires, CABA, Avenida San Martin 5481, C1417, Buenos Aires, Argentina

    Jorge Chapela

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Contributions

Study concept and design: SDQ, WSN. Acquisition of data: WSN, FI, JC. Drafting of the manuscript: SDQ, WSN. Critical revision of the manuscript for important intellectual content: SDQ, IC, WSN. Final revision and final approval for publication: SDQ. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Walter S. Nardi.

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Disclosures

Drs Sergio D Quildrian, Walter S Nardi, Facundo Iriarte, Maricel Recalde, Inés Califano and Jorge Chapela have no conflicts of interest or financial ties to disclose. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Ethical approval

The ethical approval was carried out by the local Ethics Committee of the British Hospital of Buenos Aires.

Consent to participate

Due to the retrospective nature of this study, the Ethics Committee waived the requirement for written informed consent. However, all patients signed the surgical consent form.

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Quildrian, S.D., Nardi, W.S., Iriarte, F. et al. Laparoscopic adrenalectomy for adrenal metastases of solid tumors. Surg Endosc 37, 4651–4657 (2023). https://doi.org/10.1007/s00464-023-09961-4

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