title: Patient selection for laparoscopic excision of adrenal metastases: A multicenter cohort study.
abstract: BACKGROUND
  The use of laparoscopy for the excision of adrenal metastasis remains controversial. We aimed to report oncological and perioperative outcomes of laparoscopic excision of adrenal metastases and to seek for predictive factors of unfavorable oncological outcomes.
  
  
  METHODS
  A retrospective chart review was conducted and all consecutive patients who underwent laparoscopic adrenalectomy (LA) in the setting of metastatic cancer in two academic urology departments from November 2006 through January 2014 were included. Primary tumors were categorized as pulmonary, renal or "other primary" tumors to allow statistical comparison. Unfavorable surgical outcomes were defined as the occurrence of either postoperative complications and/or positive surgical margins.
  
  
  RESULTS
  Forty-three patients who underwent a total of 45 LA were included for analysis. There were 8 complications (17.8%). Positive surgical margins were found in 12 specimens (26.7%). After a median follow-up of 37 months, estimated overall survival rates were 89.5% and 51.5% at 1 year and 5 years, respectively. In multivariable analysis the only predictor of unfavorable surgical outcomes was a tumor size >5 cm (OR = 20.5; p = 0.001). In multivariate analysis the pulmonary (OR = 0.3; p = 0.008) or "other" (OR = 0.1; p = 0.0006) origin of the primary tumor was the only prognostic factor of shorter cancer specific survival.
  
  
  CONCLUSIONS
  Laparoscopic resection of adrenal metastasis can be safely performed in most patients but is associated with an increased risk of positive surgical margins and postoperative complications in larger tumors (>5 cm). Adrenalectomy provides better oncological outcomes in metastases from renal cell carcinoma compared to other primary tumors.
authors.affiliation: Department of Urology, CHU Toulouse, Toulouse, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Gryn
authors.affiliation: Department of Urology, CHU Rennes, Rennes, France. Electronic address: peyronnetbenoit@hotmail.fr.
authors.forename: Benoit
authors.initials: B
authors.lastname: Peyronnet
authors.affiliation: Department of Urology, CHU Rennes, Rennes, France.
authors.forename: Andréa
authors.initials: A
authors.lastname: Manunta
authors.affiliation: Department of Urology, CHU Toulouse, Toulouse, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Beauval
authors.affiliation: Department of Urology, CHU Toulouse, Toulouse, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Bounasr
authors.affiliation: Department of Urology, CHU Toulouse, Toulouse, France.
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Nouhaud
authors.affiliation: Department of Pathology, CHU Rennes, Rennes, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Rioux-Leclercq
authors.affiliation: Department of Endocrinology, CHU Toulouse, Toulouse, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Caron
authors.affiliation: Department of Urology, CHU Toulouse, Toulouse, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Thoulouzan
authors.affiliation: Department of Urology, CHU Rennes, Rennes, France.
authors.forename: Grégory
authors.initials: G
authors.lastname: Verhoest
authors.affiliation: Department of Urology, CHU Toulouse, Toulouse, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Soulie
authors.affiliation: Department of Urology, CHU Rennes, Rennes, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.affiliation: Department of Urology, CHU Toulouse, Toulouse, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Huyghe
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000556:secondary* / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000556:secondary / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000556:secondary / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery; D018579:Patient Selection; D012189:Retrospective Studies
keywords: Adrenal; Adrenalectomy; Laparoscopy; Metastasis