Skip to main content

Advertisement

SpringerLink
Log in

Renal Origin and Size are Independent Predictors of Survival After Surgery for Adrenal Metastasis

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The adrenal gland is a frequent site of dissemination for certain types of tumors. Aggressive treatment remains controversial. The benefit of adrenalectomy has been observed, but the ultimate role remains to be elucidated.

Materials and Methods

We conducted a retrospective study analyzing the records of all patients with adrenal metastases submitted to adrenalectomy (open or laparoscopic) at our institution from 1981 to 2010. Baseline characteristics, operative outcomes, and survival were analyzed; predictive factors were also studied by multivariate analysis.

Results

A total of 65 patients were included with a median age of 60 years. Primary tumor sites were renal (35 %), pulmonary (23 %), melanoma (7 %), colon (2 %), liver (1 %), and others. Mean metastasis size was 7 ± 4.2 cm with a mean interval to metastasis diagnosis of 39 months. Laparoscopic approach was done in 50 % of cases. Postoperative morbidity was present in 9 %, and 2 early deaths were observed. Median overall survival was 48 months and 45 % at 5 years. Univariate and multivariate analyses showed better prognosis for renal metastases (p = 0.007 and 0.009) and those with size <5 cm (p = 0.011 and 0.031). Also in univariate analysis: synchronous (p = 0.02), symptomatic (p = 0.04), and laparoscopically operated (p = 0.033) metastasis showed higher survival rates. Metastasis from pulmonary tumors had the worst prognosis.

Conclusions

Adrenalectomy should be considered in patients with adrenal metastasis from renal carcinoma, as well as in those with small secondary lesions from other type of tumor with a controlled primary disease. The clear benefit of adrenalectomy remains to be documented in pulmonary carcinoma metastasis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Arams HL, Spiro R, Goldstein N. Metastases in carcinoma; analysis of 1000 autopsied cases. Cancer. 1950;3:74–85.

    Article  Google Scholar 

  2. Kung AW, Pun KK, Lam K, Wang C, Leung CY. Addisonian crisis as presenting feature in malignancies. Cancer. 1990;65:177–9.

    Article  PubMed  CAS  Google Scholar 

  3. Lam KY, Lo CY. Metastatic tumours of the adrenal glands: a 30-year experience in a teaching hospital. Clin Endocrinol (Oxf). 2002;56:95–101.

    Article  Google Scholar 

  4. Heniford BT, Arca MJ, Walsh RM, Gill IS. Laparoscopic adrenalectomy for cancer. Semin Surg Oncol. 1999;16:293–306.

    Article  PubMed  CAS  Google Scholar 

  5. Kuczyk M, Wegener G, Jonas U. The therapeutic value of adrenalectomy in case of solitary metastatic spread originating from primary renal cell cancer. Eur Urol. 2005;48:252–7.

    Article  PubMed  CAS  Google Scholar 

  6. Tanvetyanon T, Robinson LA, Schell MJ, Strong VE, Kapoor R, Coit DG, et al. Outcomes of adrenalectomy for isolated synchronous versus metachronous adrenal metastases in non-small-cell lung cancer: a systematic review and pooled analysis. J Clin Oncol. 2008;26:1142–7.

    Article  PubMed  Google Scholar 

  7. Collinson FJ, Lam TK, Bruijn WM, de Wilt JH, Lamont M, Thompson JF, et al. Long-term survival and occasional regression of distant melanoma metastases after adrenal metastasectomy. Ann Surg Oncol. 2008;15:1741–9.

    Article  PubMed  CAS  Google Scholar 

  8. Muth A, Persson F, Jansson S, Johanson V, Ahlman H, Wangberg B. Prognostic factors for survival after surgery for adrenal metastasis. Eur J Surg Oncol. 2010;36:699–704.

    Article  PubMed  CAS  Google Scholar 

  9. Strong VE, D’Angelica M, Tang L, Prete F, Gönen M, Coit D, et al. Laparoscopic adrenalectomy for isolated adrenal metastasis. Ann Surg Oncol. 2007;14:3392–400.

    Article  PubMed  Google Scholar 

  10. Sarela AI, Murphy I, Coit DG, Conlon KC. Metastasis to the adrenal gland: the emerging role of laparoscopic surgery. Ann Surg Oncol. 2003;10:1191–6.

    Article  PubMed  Google Scholar 

  11. Castillo OA, Vitagliano G, Kerkebe M, Parma P, Pinto I, Diaz M. Laparoscopic adrenalectomy for suspected metastasis of adrenal glands: our experience. Urology. 2007;69:637–41.

    Article  PubMed  Google Scholar 

  12. Lo CY, van Heerden JA, Soreide JA, Grant CS, Thompson GB, Lloyd RV, et al. Adrenalectomy for metastatic disease to the adrenal glands. Br J Surg. 1996;83:528–31.

    Article  PubMed  CAS  Google Scholar 

  13. Soffen EM, Solin LJ, Rubenstein JH, Hanks GE. Palliative radiotherapy for symptomatic adrenal metastases. Cancer. 1990;65:1318–20.

    Article  PubMed  CAS  Google Scholar 

  14. Higashiyama M, Doi O, Kodama K, Yokouchi H, Imaoka S, Koyama H. Surgical treatment of adrenal metastasis following pulmonary resection for lung cancer: comparison of adrenalectomy with palliative therapy. Int Surg. 1994;79:124–9.

    PubMed  CAS  Google Scholar 

  15. Luketich JD, Burt ME. Does resection of adrenal metastases from non-small cell lung cancer improve survival? Ann Thorac Surg. 1996;62:1614–6.

    Article  PubMed  CAS  Google Scholar 

  16. Mittendorf EA, Lim SJ, Schacherer CW, Lucci A, Cormier JN, Mansfield PF, et al. Melanoma adrenal metastasis: natural history and surgical management. Am J Surg. 2008;195:363–8; discussion 368–9

    Article  PubMed  Google Scholar 

  17. Sebag F, Calzolari F, Harding J, Sierra M, Palazzo FF, Henry JF. Isolated adrenal metastasis: the role of laparoscopic surgery. World J Surg. 2006;30:888–92.

    Article  PubMed  CAS  Google Scholar 

  18. Mercier O, Fadel E, de Perrot M, Mussot S, Stella F, Chapelier A, et al. Surgical treatment of solitary adrenal metastasis from non-small cell lung cancer. J Thorac Cardiovasc Surg. 2005;130:136–40.

    Article  PubMed  Google Scholar 

  19. Porte H, Siat J, Guibert B, Lepimpec-Barthes F, Jancovici R, Bernard A, et al. Resection of adrenal metastases from non-small cell lung cancer: a multicenter study. Ann Thorac Surg. 2001;71:981–5.

    Article  PubMed  CAS  Google Scholar 

  20. Gagner M, Lacroix A, Bolte E. Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med. 1992;327:1033.

    Article  PubMed  CAS  Google Scholar 

  21. Assalia A, Gagner M. Laparoscopic adrenalectomy. Br J Surg. 2004;91:1259–74.

    Article  PubMed  CAS  Google Scholar 

  22. Marangos IP, Kazaryan AM, Rosseland AR, Røsok BI, Carlsen HS, Kromann-Andersen B, et al. Should we use laparoscopic adrenalectomy for metastases? Scandinavian multicenter study. J Surg Oncol. 2009;100:43–7.

    Article  PubMed  Google Scholar 

  23. Kazaryan AM, Marangos IP, Rosseland AR, Røsok BI, Villanger O, Pinjo E, et al. Laparoscopic adrenalectomy: Norwegian single-center experience of 242 procedures. J Laparoendosc Adv Surg Tech A. 2009;19:181–9.

    Article  PubMed  Google Scholar 

Download references

Disclosure

I (we) certify that there is no conflict of interest with any financial organization.

Author information

Authors and Affiliations

  1. Department of General and Endocrine Surgery, Lille University Hospital, Lille, France

    Carlos Zerrweck MD, Robert Caiazzo MD, Baptiste Clerquin MD, Gianluca Donatini MD, Antoine Lamblin MD, Ziad El Khatib MD, Laurent Arnalsteen MD, Bruno Carnaille MD & Francois Pattou MD

Authors
  1. Carlos Zerrweck MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert Caiazzo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Baptiste Clerquin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gianluca Donatini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Antoine Lamblin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ziad El Khatib MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Laurent Arnalsteen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bruno Carnaille MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Francois Pattou MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francois Pattou MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zerrweck, C., Caiazzo, R., Clerquin, B. et al. Renal Origin and Size are Independent Predictors of Survival After Surgery for Adrenal Metastasis. Ann Surg Oncol 19, 3621–3626 (2012). https://doi.org/10.1245/s10434-012-2464-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-012-2464-6

Keywords

Search

Navigation