Elsevier

Surgery

Volume 154, Issue 6, December 2013, Pages 1215-1223
Surgery

American Association of Endocrine Surgeon
Adrenalectomy for solid tumor metastases: Results of a multicenter European study

https://doi.org/10.1016/j.surg.2013.06.021Get rights and content

Background

We assessed the results of adrenalectomy for solid tumor metastases in 317 patients recruited from 30 European centers.

Methods

Patients with histologically proven adrenal metastatic disease and undergoing complete removal(s) of the affected gland(s) were eligible.

Results

Non-small cell lung cancer (NSCLC) was the most frequent tumor type followed by colorectal and renal cell carcinoma. Adrenal metastases were synchronous (≤6 months) in 73 (23%) patients and isolated in 213 (67%). The median disease-free interval was 18.5 months. Laparoscopic resection was used in 46% of patients. Surgery was limited to the adrenal gland in 73% of patients and R0 resection was achieved in 86% of cases. The median overall survival was 29 months (95% confidence interval, 24.69–33.30). The survival rates at 1, 2, 3, and 5 years were 80%, 61%, 42%, and 35%, respectively. Patients with renal cancer showed a median survival of 84 months, patients with NSCLC 26 months, and patients with colorectal cancer 29 months (P = .017). Differences in survival between metachronous and synchronous lesions were also significant (30 vs 23 months; P = .038).

Conclusion

Surgical removal of adrenal metastasis is associated with long-term survival in selected patients.

Section snippets

Design and patients

This retrospective multicenter study was based on survey data provided by the Units of Endocrine Surgery of 30 medical institutions from 6 European countries (Italy, UK, Serbia, France, Germany, and Spain). All consecutive patients with adrenal metastases undergoing adrenalectomy in which the final histopathologic report showed explicit evidence of adrenal metastatic disease were included in the study. Exclusion criteria were as follows: Patients with inconclusive histopathologic diagnosis of

Results

Data from 317 patients who underwent adrenalectomy for adrenal metastatic disease from 1999 to 2011 were evaluated. The mean age was 58.9 ± 10.6 years, and 223 (70%) were men. Primary tumors were non-small cell lung cancer (NSCLC) in 148 patients, colorectal in 43, renal in 37, breast cancer in 11, melanoma in 11, and other in 67. The median DFI was 18.5 months (IQR, 6.6–37.3).

Adrenal metastases were synchronous in 73 (23%) patients. Isolated adrenal metastasis occurred in 234 (74%) patients.

Discussion

The main findings of this retrospective multicenter study of 317 patients with operative management of adrenal metastases from solid tumors is that removal of adrenal metastases, particularly metachronous isolated metastasis from renal cell carcinoma, is associated with favorable long-term outcome in terms of survival (median, 84 months). Also, in the multivariate analysis, treatment of the primary tumor (surgery or chemotherapy) and complete operative resection of the adrenal metastasis (R0)

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