title: [Adrenalectomy for adrenal metastases: is the laparoscopic approach beneficial for all patients?].
abstract: BACKGROUND
  Laparoscopy has become the gold-standard approach for excision of benign adrenal tumors but the question of its safety for malignant lesions is still controversial. Our aim was to evaluate the oncologic outcome of laparoscopic adrenalectomy for adrenal metastasis and to look for predictors of a negative surgical outcome.
  
  
  METHODS
  We retrospectively reviewed the charts of all patients who underwent laparoscopic adrenalectomy for suspicion of adrenal metastasis between 2007 and 2013 at a single academic institution. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. Univariate analysis was performed to determine risk factors of negative surgical outcome (positive surgical margins, complications, conversion, significant blood loss) and predictors of RFS and CSS.
  
  
  RESULTS
  Thirteen patients underwent 14 laparoscopic adrenalectomies. All patients were operated by a single highly experienced surgeon. Complications occurred in 2 patients (15%): 2 blood transfusions (Clavien-score=2). There were 3 positive surgical margins (21%). Mean length of hospital stay was 4.3 days. Unadjusted RFS and CSS were respectively 48.4% and 83.3% at 1 year, 39.5% and 66.7% at 5 years. In univariate analysis, tumor size was the only risk factor of complication (P=.009) and conversion (P=0.009). Capsule invasion and tumor size were risk factors of positive surgical margins (P=0.01 and P<0.0001). One hundred percent of complications, conversion and positive surgical margins occurred in tumor>7.5 cm on preoperative CT-scan. No predictors of RFS and CSS was found in univariate analysis.
  
  
  CONCLUSIONS
  Laparoscopic adrenalectomy for adrenal metastasis achieves good surgical and oncologic outcomes. When performed by highly experienced surgeon, complications and positive surgical margins occur only in tumors>7.5 cm. These patients may benefit from an open surgical approach.
authors.affiliation: Service d'urologie et de transplantation rénale, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France. Electronic address: peyronnetbenoit@hotmail.fr.
authors.forename: B
authors.initials: B
authors.lastname: Peyronnet
authors.affiliation: Service d'urologie et de transplantation rénale, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
authors.forename: L
authors.initials: L
authors.lastname: Tanguy
authors.affiliation: Service de pneumologie, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
authors.forename: R
authors.initials: R
authors.lastname: Corre
authors.affiliation: Service de pneumologie, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
authors.forename: H
authors.initials: H
authors.lastname: Léna
authors.affiliation: Service d'endocrinologie, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
authors.forename: F
authors.initials: F
authors.lastname: Galland
authors.affiliation: Service d'endocrinologie, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
authors.forename: I
authors.initials: I
authors.lastname: Guilhem
authors.affiliation: Service d'urologie et de transplantation rénale, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
authors.forename: R
authors.initials: R
authors.lastname: Mathieu
authors.affiliation: Service d'urologie et de transplantation rénale, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
authors.forename: G
authors.initials: G
authors.lastname: Verhoest
authors.affiliation: Service d'urologie et de transplantation rénale, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
authors.forename: S
authors.initials: S
authors.lastname: Vincendeau
authors.affiliation: Service d'anatomopathologie, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
authors.forename: N
authors.initials: N
authors.lastname: Rioux-Leclercq
authors.affiliation: Service d'urologie et de transplantation rénale, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
authors.forename: K
authors.initials: K
authors.lastname: Bensalah
authors.affiliation: Service d'urologie et de transplantation rénale, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
authors.forename: A
authors.initials: A
authors.lastname: Manunta
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D061887:Conversion to Open Surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Adrenal; Adrenalectomy; Cœlioscopie; Laparoscopy; Metastasis; Métastase; Surrénale; Surrénalectomie