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Adrenal Metastectomy is Safe in Selected Patients

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Abstract

Background

The benefit of adrenalectomy (ADX) for adrenal metastasis is not established. We evaluated outcomes after ADX for patients with adrenal metastasis.

Methods

We retrospectively analyzed the records of 90 patients who underwent ADX for metastatic disease. Overall survival (OS) after ADX was calculated using the Kaplan–Meier method. Clinical factors were evaluated for associations with OS using a Cox regression model, and with operative factors using the Wilcoxon two-sample or Fisher’s exact test.

Results

The most common primary tumor types were melanoma (35, 39 %) and lung cancer (32, 35 %). A total of 49 (54 %) patients had isolated adrenal metastasis; 55 (61 %) underwent laparoscopic resection (LADX). Median OS was 2.46 years (range < 1 month–15 years), and 5-year survival rate was 38 % (6 % standard error). Most patients experienced disease progression (56, 62 %) despite achieving disease-free status following ADX (78, 86 %). When compared with the open approach, LADX was associated with smaller tumor size, as well as reduced blood loss, operative time, and length of stay (all p < 0.0001), and no difference in OS (p = 0.4122) or complications (p = 1). Isolated adrenal bed recurrence was similar in LADX (N = 3, 5 %) and open ADX (N = 2, 6 %) (p = 1), and did not affect OS (p = 0.2). Larger tumors were associated with shorter median OS (p = 0.0014).

Conclusions

ADX for metastasis can be safely performed in selected patients. Some patients with adrenal metastasis achieve prolonged survival following ADX. Compared with an open approach, LADX has no measurable oncologic disadvantage, minimizes morbidity, and should be considered when tumor characteristics permit.

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Acknowledgments

The authors would like to thank Mr. Roland Bassett for his assistance on the statistical analysis and Ms. Melissa Burkett for editorial assistance in manuscript preparation.

Conflict of interest

The authors have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler Dr., Unit 1484, Houston, TX, 77030, USA

    Minerva Angelica Romero Arenas, Elizabeth G. Grubbs, Jeffrey E. Lee & Nancy D. Perrier

  2. Department of Surgery, Sinai Hospital of Baltimore, 2401 W. Belvedere Ave., Baltimore, MD, 21215, USA

    Minerva Angelica Romero Arenas

  3. Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler Dr., Unit 1411, Houston, TX, 77030, USA

    Dawen Sui

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  1. Minerva Angelica Romero Arenas
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  2. Dawen Sui
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  3. Elizabeth G. Grubbs
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  4. Jeffrey E. Lee
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  5. Nancy D. Perrier
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Correspondence to Minerva Angelica Romero Arenas.

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Romero Arenas, M.A., Sui, D., Grubbs, E.G. et al. Adrenal Metastectomy is Safe in Selected Patients. World J Surg 38, 1336–1342 (2014). https://doi.org/10.1007/s00268-014-2454-x

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  • DOI: https://doi.org/10.1007/s00268-014-2454-x

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