title: [Diagnosis and therapy of metastatic tumors in the adrenal gland--a report of 21 cases].
abstract: OBJECTIVE
  Recently, the occurrence of metastasis to the adrenal gland is increasing, while the early and differentiated diagnosis still remains difficult. Whether metastasis to the adrenal gland needs to be resected and when and how the resection should be done are controversial. This study was to explore the surgical indications of metastasis to the adrenal gland and the role of laparoscopic adrenalectomy in the treatment of this disease.
  
  
  METHODS
  Clinical data of 21 patients with metastatic tumors in the adrenal gland, treated in Cancer Center of Sun Yat-sen University from Mar. 1997 to Mar. 2004, were analyzed retrospectively. Literature of the diagnosis and therapy was reviewed.
  
  
  RESULTS
  The diagnosis rates of ultrasonography and spiral or thin-cut computed tomography (CT) were 70.0% (7/10) and 84.6% (11/13). Ten patients received adrenalectomy with negative resection margins, 4 of them received laparoscopic adrenalectomy. The patients survived for 1-67 months, with a median of 18 months. One patient was still alive 67 months after the adrenalectomy, and 2 was lost. Eleven patients received palliative operation or no treatment, 10 of them survived for 5-28 months with a median of 13 months, while 1 was lost during follow-up. The difference in survival rates between the 2 groups was not significant (P=0.346).
  
  
  CONCLUSIONS
  Ultrasonography and CT are important diagnosis methods for metastatic adrenal cancer. No evidence of tumor invasion revealed by preoperative imaging studies, no adjacent lymphadenopathy and no extraladrenal metastasis are indications of adrenalectomy. Laparoscopic adrenalectomy is safe and effective for those well-selected patients.
authors.affiliation: Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, P. R. China. uroliang@126.com
authors.forename: Yue-You
authors.initials: YY
authors.lastname: Liang
authors.forename: Yu-Ping
authors.initials: YP
authors.lastname: Dai
authors.forename: Ming-Xin
authors.initials: MX
authors.lastname: Cao
authors.forename: Ke-Li
authors.initials: KL
authors.lastname: Zheng
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D036542:Tomography, Spiral Computed; D014463:Ultrasonography