The role of laparoscopic resection of metastases to adrenal glands

Abstract

Background: The potential role of the laparoscopic approach for metastases to the adrenal gland is debated. We review here a series of patients consecutively submitted to laparoscopic adrenalectomy (LA) for suspected adrenal metastasis (AM).Methods: Retrospective study (consecutive series) of LA for AM. We measured parameters associated to primary tumor and metastasis. Statistical analysis: stepwise regression model.Results: Thirty-seven LA were performed on 36 patients. The mean age was 62.1 yrs. The side was right in 13 cases. Primary tumor was in the lung (n=22), breast (n=4), colon-rectum (n=4), kidney (n=3), thyroid, melanoma and ovary (n=1 each). Thirty-three out of 37 were confirmed to be AM (mean diameter 50 mm).Twenty-five were single metastasis. One LA was converted due to cava vein infiltration. Mean operative time was 142 min', median p.o. hospital stay was 3 days. After a mean follow-up of 33 months, 9 patients (25%) were alive free of disease, 6 (17%) were alive with disease. Mean post-adrenalectomy DFI was 19 months (range, 0-97 months), and it was the most predictive variable for survival (P<0.001). Conclusions:The dimensions and absence of invasion on imaging, the evolutive status of the disease and the performance status of the patient are key factors for LA, which is associated with adequate oncologic results, a quicker postoperative recovery, and potential survival benefits.

The outcomes of adrenalectomy for solitary adrenal metastasis: A 17‐year single‐center experience

“…Consequently, our chief concern was the long‐term oncologic outcomes when laparoscopic adrenalectomy is used for malignant tumors. To date, several reports have demonstrated that laparoscopic adrenalectomy can be performed safely with similar oncologic outcomes and survival compared to open adrenalectomy . In this study, the oncologic outcomes, such as local recurrence rate and survival, were similar in the laparoscopic and open groups.…”

“…To date, several reports have demonstrated that laparoscopic adrenalectomy can be performed safely with similar oncologic outcomes and survival compared to open adrenalectomy. [10][11][12]16,[21][22][23] In this study, the oncologic outcomes, such as local recurrence rate and survival, were similar in the laparoscopic and open groups. Although there may be selection bias for the laparoscopic approach, especially with regards to the adrenal tumor size, 11,12 laparoscopic adrenalectomy can be a safe alternative compared to open adrenalectomy for isolated adrenal metastases.…”

“…To achieve tolerable local control, the open surgery should be considered for the cases with large tumor size and local invasion on imaging. 1,5,23 In conclusion, our study showed that adrenalectomy for isolated adrenal metastasis may be beneficial for selected patients with various types of malignancy. Synchronous metastasis and a tumor size ≥ 4 cm were potential prognostic factors for a shorter overall survival.…”

“…Although there may be selection bias for the laparoscopic approach, especially with regards to the adrenal tumor size, laparoscopic adrenalectomy can be a safe alternative compared to open adrenalectomy for isolated adrenal metastases. To achieve tolerable local control, the open surgery should be considered for the cases with large tumor size and local invasion on imaging …”

Fine‐needle aspiration of adrenal lesions: A 20‐year single institution experience with comparison of percutaneous and endoscopic ultrasound guided approaches

“…Accurately diagnosing a metastasis by fine‐needle biopsy may spare a patient an unnecessary surgery and at the same time allow for collection of enough sample to conduct ancillary testing needed to guide targeted therapies . Conversely, preoperative characterization of both primary adrenal neoplasms and metastases to the adrenals may allow for conservative management and/or tailored approaches to surgical interventions . Fine‐needle aspiration (FNA) biopsies of adrenal mass lesions were, for decades, primarily approached by interventional radiologists using percutaneous approaches guided by computed tomography (CT).…”