title: Modified anatomical retroperitoneoscopic adrenalectomy for adrenal metastatic tumor: technique and survival analysis.
abstract: BACKGROUND
  In a previous experience, anatomical retroperitoneoscopic adrenalectomy (ARA) was proven safe, effective, and technically efficient for surgical adrenal diseases. However, laparoscopic adrenalectomy for adrenal metastasis is controversial. We evaluated the safety, effectiveness, and efficiency of modified ARA technique for adrenal metastasis and predicted survival factors.
  
  
  METHODS
  From 2000 to 2010, a consecutive series of 75 patients with adrenal metastases underwent 78 ARAs (three bilateral ARAs). Three modifications and one key procedure were specified in this study. Medical records and follow-up data were retrospectively studied. Then, the surgery data of ARA were compared with those of other approaches to evaluate its safety, effectiveness, and efficiency. Additionally, univariate and multivariate analyses were used to predict the risk factors for survival.
  
  
  RESULTS
  The most common primary tumor was renal cell carcinoma (RCC, n = 26), followed by non-small-cell lung carcinoma (NSCLC, n = 23), and hepatocellular carcinoma (HCC, n = 12). A total of 76 successful ARAs and two conversions to open surgery were performed, with a median operation time of 53 (range, 40-250) min and median estimated blood loss of 25 (range, 10-700) mL. The local recurrence rate was 5.3 %, and the median survival was 24 months. These data were comparable with or even better than other approaches in previous studies. The independent prognostic factors of survival were body mass index (BMI, p < 0.001), tumor type (p < 0.001), tumor size (≥ 4 cm vs. <4 cm, p = 0.017), and margin status (negative vs. positive, p = 0.011).
  
  
  CONCLUSIONS
  ARA is a safe and effective approach for the management of adrenal metastasis in selected patients. BMI, tumor type, tumor size, and margin status may independently predict survival.
authors.affiliation: Department of Urology, Chinese PLA General Hospital/Military Postgraduate Medical School, Beijing 100853, People's Republic of China.
authors.forename: Xin
authors.initials: X
authors.lastname: Ma
authors.forename: Hongzhao
authors.initials: H
authors.lastname: Li
authors.forename: Xu
authors.initials: X
authors.lastname: Zhang
authors.forename: Qingbo
authors.initials: Q
authors.lastname: Huang
authors.forename: Baojun
authors.initials: B
authors.lastname: Wang
authors.forename: Taoping
authors.initials: T
authors.lastname: Shi
authors.forename: Dongliang
authors.initials: D
authors.lastname: Hu
authors.forename: Qing
authors.initials: Q
authors.lastname: Ai
authors.forename: Shangwen
authors.initials: S
authors.lastname: Liu
authors.forename: Jiangping
authors.initials: J
authors.lastname: Gao
authors.forename: Yong
authors.initials: Y
authors.lastname: Yang
authors.forename: Jun
authors.initials: J
authors.lastname: Dong
authors.forename: Tao
authors.initials: T
authors.lastname: Zheng
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods* / Q000401:mortality; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D061646:Operative Time; D012189:Retrospective Studies; D012307:Risk Factors; D047368:Tumor Burden