Adrenal metastectomy is safe in selected patients.
BACKGROUND
The benefit of adrenalectomy (ADX) for adrenal metastasis is not established. We evaluated outcomes after ADX for patients with adrenal metastasis.


METHODS
We retrospectively analyzed the records of 90 patients who underwent ADX for metastatic disease. Overall survival (OS) after ADX was calculated using the Kaplan-Meier method. Clinical factors were evaluated for associations with OS using a Cox regression model, and with operative factors using the Wilcoxon two-sample or Fisher's exact test.


RESULTS
The most common primary tumor types were melanoma (35, 39 %) and lung cancer (32, 35 %). A total of 49 (54 %) patients had isolated adrenal metastasis; 55 (61 %) underwent laparoscopic resection (LADX). Median OS was 2.46 years (range < 1 month-15 years), and 5-year survival rate was 38 % (6 % standard error). Most patients experienced disease progression (56, 62 %) despite achieving disease-free status following ADX (78, 86 %). When compared with the open approach, LADX was associated with smaller tumor size, as well as reduced blood loss, operative time, and length of stay (all p < 0.0001), and no difference in OS (p = 0.4122) or complications (p = 1). Isolated adrenal bed recurrence was similar in LADX (N = 3, 5 %) and open ADX (N = 2, 6 %) (p = 1), and did not affect OS (p = 0.2). Larger tumors were associated with shorter median OS (p = 0.0014).


CONCLUSIONS
ADX for metastasis can be safely performed in selected patients. Some patients with adrenal metastasis achieve prolonged survival following ADX. Compared with an open approach, LADX has no measurable oncologic disadvantage, minimizes morbidity, and should be considered when tumor characteristics permit.
Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler Dr., Unit 1484, Houston, TX, 77030, USA, MARomero@mdanderson.org.
Minerva Angelica
MA
Romero Arenas
Dawen
D
Sui
Elizabeth G
EG
Grubbs
Jeffrey E
JE
Lee
Nancy D
ND
Perrier
D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods* / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001707:Biopsy, Needle; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D061214:Patient Safety / Q000706:statistics & numerical data*; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult