title: Renal origin and size are independent predictors of survival after surgery for adrenal metastasis.
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.
  
  
  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.
authors: Department of General and Endocrine Surgery, Lille University Hospital, Lille, France.
authors: Carlos
authors: C
authors: Zerrweck
authors: Robert
authors: R
authors: Caiazzo
authors: Baptiste
authors: B
authors: Clerquin
authors: Gianluca
authors: G
authors: Donatini
authors: Antoine
authors: A
authors: Lamblin
authors: Ziad
authors: Z
authors: El Khatib
authors: Laurent
authors: L
authors: Arnalsteen
authors: Bruno
authors: B
authors: Carnaille
authors: Francois
authors: F
authors: Pattou
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D000315:Adrenalectomy; D000368:Aged; D019540:Area Under Curve; D002277:Carcinoma / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000473:pathology*; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D012509:Sarcoma / Q000473:pathology / Q000556:secondary / Q000601:surgery; D047368:Tumor Burden