title: Adrenalectomy improves outcomes of selected patients with metastatic carcinoma.
abstract: BACKGROUND
  Indications and survival benefit for adrenalectomy (ADX) in the setting of metastasis are not clearly defined. We aimed to determine which patients with primary malignancies may benefit from ADX performed for metastasis. Mayo Clinic institutional outcomes in patients with metastatic disease to the adrenal(s) treated by adrenalectomy were compared to stage-matched historical controls from the Surveillance Epidemiology and End Results (SEER) database.
  
  
  METHODS
  A retrospective review (1992-2010) was conducted to identify patients treated with ADX for metastatic cancer at Mayo Clinic, Rochester. Associations of clinical, surgical, and pathologic features with overall survival (OS) were evaluated using Cox proportional regression models. OS for those treated with ADX was compared with that for SEER database stage-matched patients who underwent primary resection without resection of distant disease using log-rank tests.
  
  
  RESULTS
  A total of 166 patients underwent ADX for metastatic primaries involving the kidney 60, lung 24, sarcoma 19, colon 15, pancreas 13, and other-35. Patients with sarcoma and kidney, lung, and pancreatic tumors who underwent ADX had better OS at 1, 2, and 3 years than did the SEER-matched controls. Respectively, the rates were for sarcoma (100, 93, 86% vs. 57, 36, 30%), kidney (86, 80, 72% vs. 55, 37, 27%), lung (91, 69, 52% vs. 52, 34, 25%), and pancreas (79, 56, 45% vs. 33, 20, 12%). Univariate analysis identified primary diagnosis <2 years before ADX, other distant site, pancreatic primary, palliative operation, and persistent disease as risk factors for death.
  
  
  CONCLUSIONS
  An aggressive surgical approach results in improved OS in patients with metastatic disease arising from soft tissues, kidney, lung, and pancreas. Other tumors may benefit, but larger study cohorts are needed for a meaningful comparison.
authors.affiliation: Division of Gastroenterologic and General Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Bianca J
authors.initials: BJ
authors.lastname: Vazquez
authors.forename: Melanie L
authors.initials: ML
authors.lastname: Richards
authors.forename: Christine M
authors.initials: CM
authors.lastname: Lohse
authors.forename: Geoffrey B
authors.initials: GB
authors.lastname: Thompson
authors.forename: David R
authors.initials: DR
authors.lastname: Farley
authors.forename: Clive S
authors.initials: CS
authors.lastname: Grant
authors.forename: Marianne
authors.initials: M
authors.lastname: Huebner
authors.forename: Jose
authors.initials: J
authors.lastname: Moreno
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D018426:SEER Program; D012509:Sarcoma / Q000401:mortality / Q000473:pathology; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis; D016896:Treatment Outcome