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Solaini L, Ministrini S, Tomasoni M, Merigo G, Gaverini G, Bertoloni GP, Tiberio GAM. Adrenalectomy for metastasis: long-term results and predictors of survival. Endocrine 2015; 50:187-92. [PMID: 25863489 DOI: 10.1007/s12020-015-0596-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 03/31/2015] [Indexed: 12/17/2022]
Abstract
The purpose of this study was to analyze our experience with surgically treated isolated adrenal metastases in order to find those factors which can significantly affect survival. This method includes a retrospective single-center chart review. We evaluated how overall survival and disease-free survival (DFS) were influenced by demographic, tumor, and procedure-related variables. Thirty-seven adrenalectomies were performed in 34 patients. Procedures included 25 laparoscopic and 12 open adrenalectomies. Median follow-up was 49 months. Median overall survival was 63 months. Patients submitted to laparoscopic approach had a median survival of 57 months while it was 65 months for those who underwent open procedure (p = 0.67). DFS was 30 months, and these were 35 and 25 months after laparoscopic approach and open approach, respectively (p = 0.59). The concurrent resection of the adrenal metastasis with the primary tumor was the only factor influencing DFS (HR 6.8 95 % CI 1.2-37.3, p = 0.02). Patients with non-small cell lung cancer (n = 15) had a median survival of 63 months and DFS of 35 months. Our experience confirms that adrenalectomy, regardless of the surgical approach, can offer durable disease-free and overall survival outcomes for surgical candidates with isolated adrenal metastases.
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Affiliation(s)
- Leonardo Solaini
- Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia, Pl.e Spedali Civili 1, Brescia, Italy,
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Pędziwiatr M, Wierdak M, Natkaniec M, Matłok M, Białas M, Major P, Budzyński P, Hubalewska-Dydejczyk A, Budzyński A. Laparoscopic transperitoneal lateral adrenalectomy for malignant and potentially malignant adrenal tumours. BMC Surg 2015; 15:101. [PMID: 26314582 PMCID: PMC4551373 DOI: 10.1186/s12893-015-0088-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 08/21/2015] [Indexed: 12/05/2022] Open
Abstract
Background Laparoscopic adrenalectomy is still controversial in cases where malignancy is suspected. However, many proponents of this technique argue that in the hands of an experienced surgeon, laparoscopy can be safely performed. The aim of this study is to present our own experience with the application of laparoscopic surgery for the treatment of malignant and potentially malignant adrenal tumours. Methods Our analysis included 52 patients who underwent laparoscopic adrenalectomy in 2003–2014 due to a malignant or potentially malignant adrenal tumour. Inclusion criteria were primary adrenal malignancy, adrenal metastasis or pheochromocytoma with a PASS score greater than 6. We analyzed the conversion rate, intra- and postoperative complications, intraoperative blood loss and R0 resection rate. Survival was estimated using the Kaplan-Meier method. Results Conversion was necessary in 5 (9.7 %) cases. Complications occurred in a total of 6 patients (11.5 %). R0 resection was achieved in 41 (78.8 %) patients and R1 resection in 9 (17.3 %) patients. In 2 (3.9 %) cases R2 resection was performed. The mean follow-up time was 32.9 months. Survival depended on the type of tumour and was comparable with survival after open adrenalectomy presented in other studies. Conclusions We consider that laparoscopic surgery for adrenal malignancy can be an equal alternative to open surgery and in the hand of an experienced surgeon it guarantees the possibility of noninferiority. Additionally, starting a procedure with laparoscopy allows for minimally invasive evaluation of peritoneal cavity. The key element in surgery for any malignancy is not the surgical access itself but the proper technique.
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Affiliation(s)
- Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501, Kraków, Poland.
| | - Mateusz Wierdak
- Department of Physiology, Jagiellonian University, Grzegórzecka 16, 31-531, Kraków, Poland
| | - Michał Natkaniec
- 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501, Kraków, Poland
| | - Maciej Matłok
- 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501, Kraków, Poland
| | - Magdalena Białas
- Department of Pathology, Jagiellonian University, Grzegórzecka 16, 31-531, Kraków, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501, Kraków, Poland
| | - Piotr Budzyński
- 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501, Kraków, Poland
| | | | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501, Kraków, Poland
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Single center outcomes of laparoscopic transperitoneal lateral adrenalectomy – Lessons learned after 500 cases: A retrospective cohort study. Int J Surg 2015; 20:88-94. [DOI: 10.1016/j.ijsu.2015.06.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 05/04/2015] [Accepted: 06/02/2015] [Indexed: 12/14/2022]
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Hasegawa T, Yamakado K, Nakatsuka A, Uraki J, Yamanaka T, Fujimori M, Miki M, Sasaki T, Sakuma H, Sugimura Y. Unresectable Adrenal Metastases: Clinical Outcomes of Radiofrequency Ablation. Radiology 2015; 277:584-93. [PMID: 25997031 DOI: 10.1148/radiol.2015142029] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To retrospectively evaluate the clinical outcomes of radiofrequency (RF) ablation for the treatment of unresectable adrenal metastasis. MATERIALS AND METHODS The institutional review board approved this retrospective study, and informed consent to perform adrenal RF ablation was obtained from all patients. From February 2005 through May 2014, 35 patients (25 men and 10 women; mean age, 64.7 years ± 9.6; age range, 39-82 years) underwent RF ablation to treat 41 metastatic adrenal tumors from lung cancer (n = 15), renal cell carcinoma (n = 9), colorectal cancer (n = 5), hepatocellular carcinoma (n = 4), and other tumors (n = 2). Tumors ranged in size from 1.2 to 8.2 cm (mean, 3.3 cm ± 1.6). The diagnosis was established mainly on the basis of radiologic findings. Adrenal arterial embolization was combined with RF ablation in 12 of the 35 patients (34%). Technical success, safety, local tumor progression, and survival were evaluated. The Kaplan-Meier method and Cox proportional hazard model were used to evaluate prognostic factors. RESULTS There were 48 completed sessions with planned procedures and treatment protocols with no mortality and a major complication rate of 8.3% (four of 48 sessions). Tumor enhancement disappeared after initial adrenal RF ablation in 33 of the 35 patients (94%). Local tumor progression developed in eight of the 35 patients (23%); two patients received repeated RF ablation, resulting in adrenal tumor control in 27 of the 35 patients (77%) at the last follow-up (mean, 30.1 months ± 27.5; range 1.2-96.8 months). The 1-, 3-, and 5-year overall survival rates were 75% (95% confidence interval [CI], 61%, 90%), 34% (95% CI: 17%, 52%), and 30% (95% CI: 13%, 48%), respectively, with a median survival time of 26.0 months. Existence of extra-adrenal tumors (P = .005) and age of 65 years or older (P = .04) were significant indicators of a poor prognosis. CONCLUSION Adrenal RF ablation is a feasible and useful method for controlling adrenal metastases and offers patients opportunities for improved survival.
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Affiliation(s)
- Takaaki Hasegawa
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Koichiro Yamakado
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Atsuhiro Nakatsuka
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Junji Uraki
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Takashi Yamanaka
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Masashi Fujimori
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Manabu Miki
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Takeshi Sasaki
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Hajime Sakuma
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Yoshiki Sugimura
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
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Vishnevskiĭ AV, Andreĭtseva OI, Kharazov AF, Gritsiuta AI, Kalinin DV, Zhavoronkova OI. [Epinephros metastasis of colorectal cancer complicated by tumor thrombosis of inferior vena cava]. Khirurgiia (Mosk) 2015:68-72. [PMID: 25909557 DOI: 10.17116/hirurgia2015168-72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Metastasis of colorectal cancer (CRC) in an adrenal gland develops in 1.8% of cases (in synchrony or in metachrony) for patients with liver metastatic lesion and aggravates for certain prognosis for long-term survival. There are no data concerning colorectal metastasis in an adrenal gland with tumor thrombosis of inferior vena cava (IVC) in world-wide literature. A patient, 57 years old, on 04.29.11 underwent palliative distal sigmoid colectomy in respect of CRC pT3N2M1 (metastatic lesion of liver right lobe). Process stabilization was noticed after 4 courses of polychemotherapy. On 07.28.11 she underwent right-sided hemihepatectomy. She underwent further 4 courses in accordance with the same scheme. On 12.06.13 case-control USI and multi-layer spiral CT of abdominal cavity detected mass lesion in the right adrenal gland, it was estimated as metastatic lesion with compression of inferior vena cava and thrombosis in its lumen at retroliver segment level. Right-sided adrenalectomy. Thrombectomy of IVC was carried out in the condition of total vascular isolation. Taking into account metastasis respectability in an adrenal gland and small extent of a tumor thrombus we suppose the described surgical practice to be justified. The problem of neoadjuvant chemotherapy prescription is still controversial.
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Affiliation(s)
- A V Vishnevskiĭ
- Institut khirurgii im. A.V. Vishnevskogo Minzdrava RF, Moskva
| | - O I Andreĭtseva
- Institut khirurgii im. A.V. Vishnevskogo Minzdrava RF, Moskva
| | - A F Kharazov
- Institut khirurgii im. A.V. Vishnevskogo Minzdrava RF, Moskva
| | - A Iu Gritsiuta
- Institut khirurgii im. A.V. Vishnevskogo Minzdrava RF, Moskva
| | - D V Kalinin
- Institut khirurgii im. A.V. Vishnevskogo Minzdrava RF, Moskva
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Hornstein I, Schwarz C, Ebbing S, Hoppe-Lotichius M, Otto G, Lang H, Musholt TJ. Surgical resection of metastases to the adrenal gland: a single center experience. Langenbecks Arch Surg 2015; 400:333-9. [PMID: 25726026 DOI: 10.1007/s00423-015-1293-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 02/18/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Only limited data exist on the treatment and outcome of adrenal metastases that derive from different primary tumor entities. Due to the lack of evidence, it is difficult to determine the indication for surgical resection. METHODS We assessed the outcome of 45 patients (28 men, 17 women) with adrenal metastases who underwent surgery (1990-2014). The median age at the time of adrenal surgery was 62 years (range 44-77 years). We were able to evaluate follow-up data of 41 patients. RESULTS Primary tumor types were liver n = 12 (hepatocellular carcinoma n = 9, cholangiocellular carcinoma n = 2, sarcoma n = 1), upper GI tract n = 5 (esophagus n = 2, stomach n = 3), lung n = 9, kidney n = 6, neuroendocrine tumors n = 3, colon n = 2, ovarial n = 2, melanoma n = 2, others n = 4. The overall median survival time was 14 months (95 % CI 8.375-19.625). The survival rates at 1, 2, 5, and 10 years were 60, 31, 21, and 11 %, respectively. There were statistically significant differences in the survival time according to the resection status (R0 vs. R1/R2) (p < 0.001) and the type of the primary tumor (p = 0.009), while the metachronous or synchronous occurrence of adrenal metastases did not affect the prognosis. CONCLUSIONS Resection of adrenal metastases can improve the survival if patients are carefully selected, the tumor is completely resected, and the intervention is integrated into a multidisciplinary oncologic treatment strategy.
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Affiliation(s)
- I Hornstein
- Department of General, Visceral and Transplantation Surgery, University Medicine of the Johannes, Gutenberg University Mainz, Mainz, Germany
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57
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Hepatic Resection for Extrahepatic Metastatic Disease: When Is It Reasonable? CURRENT COLORECTAL CANCER REPORTS 2015. [DOI: 10.1007/s11888-015-0263-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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58
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Evaluation of stereotactic body radiation therapy in the management of adrenal metastases from non-small cell lung cancer. TUMORI JOURNAL 2015; 101:98-103. [PMID: 25702673 DOI: 10.5301/tj.5000222] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2014] [Indexed: 02/08/2023]
Abstract
AIMS AND BACKGROUND In this retrospective analysis, we evaluated the use of stereotactic body radiation therapy in the management of adrenal metastases from non-small cell lung cancer and report our single center experience. METHODS AND STUDY DESIGN Fifteen non-small cell lung cancer patients (9 male, 6 female) with 17 adrenal metastases referred to Gulhane Military Medical Academy Radiation Oncology Department were treated using active breathing control-guided stereotactic body radiation therapy between December 2009 and October 2013. Dose per fraction was 10 Gy to deliver a total dose of 30 Gy over 3 consecutive days for all metastatic adrenal lesions. The mean gross tumor volume was 28.4 cc (range 6.6-101.5) and mean planning target volume was 57.4 cc (range 16.5-143.8). RESULTS At a median follow-up of 16 months, local control was 86.7% and overall survival was 33.3%. Median disease-free survival was 10 months. Treatment response according to RECIST was categorized as complete response in 3 patients (20%), partial response in 5 patients (33.3%), stable disease in 5 patients (33.3%), and progressive disease in 2 patients (13.3%). Most common acute toxicity was grade 1 nausea (n = 7) and grade 1 fatigue (n = 12). There was no case of grade ≥3 acute or late toxicity. CONCLUSIONS Stereotactic body radiation therapy offers a safe and efficacious management strategy for adrenal metastases from non-small cell lung cancer by providing excellent local control with negligible treatment related toxicity.
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Affiliation(s)
- H Dralle
- Universitätsklinik für Allgemein-, Viszeral- und Gefäßchirurgie, Medizinische Fakultät, Universitätsklinikum Halle, Ernst-Grube-Str. 40, 06097, Halle (Saale), Deutschland,
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Bartlett EK, Simmons KD, Wachtel H, Roses RE, Fraker DL, Kelz RR, Karakousis GC. The rise in metastasectomy across cancer types over the past decade. Cancer 2014; 121:747-57. [PMID: 25377689 DOI: 10.1002/cncr.29134] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 09/10/2014] [Accepted: 10/10/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although studies of metastasectomy have been limited primarily to institutional experiences, reports of favorable long-term outcomes have generated increasing interest. In the current study, the authors attempted to define the national practice patterns in metastasectomy for 4 common malignancies with varying responsiveness to systemic therapy. METHODS The National (Nationwide) Inpatient Sample was used to estimate the national incidence of metastasectomy for colorectal cancer, lung cancer, breast cancer, and melanoma from 2000 through 2011. Incidence-adjusted rates were determined for liver, lung, brain, small bowel, and adrenal metastasectomies. The average annual percentage change (AAPC) in metastasectomy by cancer type was calculated using joinpoint regression. RESULTS Colorectal cancer was the most common indication for metastasectomy (87,407 cases; 95% confidence interval [95% CI], 86,307-88,507 cases) followed by lung cancer (58,245 cases; 95% CI, 57,453-59,036 cases), breast cancer (26,271 cases; 95% CI, 25,672-26,870 cases), and melanoma (20,298 cases; 95% CI, 19,897-20,699 cases). Metastasectomy increased significantly for all cancer types over the study period: colorectal cancer (AAPC, 6.83; 95% CI, 5.7-7.9), lung cancer (AAPC, 5.8; 95% CI, 5.1-6.4), breast cancer (AAPC, 5.5; 95% CI, 3.7-7.3), and melanoma (AAPC, 4.03; 95% CI, 2.1-6.0). Despite an increasing number of comorbidities in patients undergoing metastasectomy (P<.05 for each cancer type), inpatient mortality rates after metastasectomy fell for all cancer types, most significantly for colorectal (AAPC, -5.49; 95% CI, -8.2 to -2.7) and lung (AAPC, -6.2; 95% CI, -11.7 to -0.3) cancers. The increasing performance of metastasectomy was largely driven by high-volume institutions, in which patients had a lower mean number of comorbidities (P<.01 for all cancer types) and lower inpatient mortality (P<.01 for all cancers except melanoma). CONCLUSIONS From 2000 through 2011, the performance of metastasectomy increased substantially across common cancer types, notwithstanding various advances in systemic therapies. Metastasectomy was performed more safely, despite increasing patient comorbidity. High-volume institutions appeared to drive practice patterns.
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Affiliation(s)
- Edmund K Bartlett
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Taira N, Kawabata T, Ichi T, Kushi K, Yohena T, Kawasaki H, Ishikawa K. Long-term survival after surgical treatment of metachronous bilateral adrenal metastases of non-small cell lung carcinoma. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:444-6. [PMID: 25317919 PMCID: PMC4206476 DOI: 10.12659/ajcr.891027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patient: Male, 70 Final Diagnosis: Bilateral adrenal metastasis Symptoms: — Medication: — Clinical Procedure: Surgery Specialty: Surgery
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Affiliation(s)
- Naohiro Taira
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Japan
| | - Tsutomu Kawabata
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Japan
| | - Takaharu Ichi
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Japan
| | - Kazuaki Kushi
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Japan
| | - Tomofumi Yohena
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Japan
| | - Hidenori Kawasaki
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Japan
| | - Kiyoshi Ishikawa
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Japan
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Wardak Z, Meyer J, Ghayee H, Wilfong L, Timmerman R. Adrenal insufficiency after stereotactic body radiation therapy for bilateral adrenal metastases. Pract Radiat Oncol 2014; 5:e177-e181. [PMID: 25413390 DOI: 10.1016/j.prro.2014.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/05/2014] [Accepted: 08/20/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Zabi Wardak
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey Meyer
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hans Ghayee
- Department of Internal Medicine-Endocrinology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lalan Wilfong
- Texas Oncology-Dallas Presbyterian Cancer Center, Dallas, Texas
| | - Robert Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
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[Adrenalectomy for adrenal metastases: is the laparoscopic approach beneficial for all patients?]. Prog Urol 2014; 24:1069-75. [PMID: 25242339 DOI: 10.1016/j.purol.2014.08.236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/29/2014] [Accepted: 08/19/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION 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. PATIENTS AND 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. CONCLUSION 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.
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Kuritzkes B, Parikh M, Melamed J, Hindman N, Pachter HL. False-Positive Rate of Positron Emission Tomography/Computed Tomography for Presumed Solitary Metastatic Adrenal Disease in Patients with Known Malignancy. Ann Surg Oncol 2014; 22:437-40. [DOI: 10.1245/s10434-014-4031-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Indexed: 12/12/2022]
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Reck M, Popat S, Reinmuth N, De Ruysscher D, Kerr KM, Peters S. Metastatic non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 25 Suppl 3:iii27-39. [PMID: 25115305 DOI: 10.1093/annonc/mdu199] [Citation(s) in RCA: 541] [Impact Index Per Article: 54.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- M Reck
- Department of Thoracic Oncology, LungenClinic, Grosshansdorf Member of the German Center for Lung Research (DZL), Germany
| | - S Popat
- Royal Marsden Hospital NHS Foundation Trust, London Royal Marsden Hospital NHS Foundation Trust, Surrey, UK
| | - N Reinmuth
- Department of Thoracic Oncology, LungenClinic, Grosshansdorf Member of the German Center for Lung Research (DZL), Germany
| | - D De Ruysscher
- Department of Radiation Oncology, University Hospitals Leuven/ KU Leuven, Leuven, Belgium
| | - K M Kerr
- Department of Pathology, Aberdeen Royal Infirmary and Aberdeen University Medical School, Aberdeen, UK
| | - S Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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Romero Arenas MA, Sui D, Grubbs EG, Lee JE, Perrier ND. Adrenal metastectomy is safe in selected patients. World J Surg 2014; 38:1336-42. [PMID: 24452292 DOI: 10.1007/s00268-014-2454-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Minerva Angelica Romero Arenas
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler Dr., Unit 1484, Houston, TX, 77030, USA,
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Metachronous bilateral isolated adrenal metastasis from rectal adenocarcinoma: a case report. Case Rep Gastrointest Med 2014; 2014:516403. [PMID: 24860684 PMCID: PMC4016941 DOI: 10.1155/2014/516403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 01/01/2014] [Indexed: 01/10/2023] Open
Abstract
We report a case of adrenal metastasis from colorectal cancer in a 54-year-old woman. Nine months after resection for advanced rectal carcinoma, a computed tomography scan revealed bilateral adrenal metastasis. The level of serum carcinoembryonic antigen was normal. A bilateral adrenalectomy was performed after chemotherapy. Histopathological examination showed adenocarcinoma, compatible with metastasis from the rectal cancer. Adrenal metastasis should be considered in the patients' follow-up for colorectal cancer.
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Simutis G, Lengvenis G, Beiša V, Strupas K. Endoscopic retroperitoneal adrenalectomy for adrenal metastases. Int J Endocrinol 2014; 2014:806194. [PMID: 25276132 PMCID: PMC4170751 DOI: 10.1155/2014/806194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/20/2014] [Accepted: 08/05/2014] [Indexed: 12/13/2022] Open
Abstract
Objectives. To evaluate whether retroperitoneal approach for adrenalectomy is a safe and effective treatment for adrenal metastases (AM). Methods. From June 2004 to January 2014, nine consecutive patients with AM were treated with endoscopic retroperitoneal adrenalectomy (ERA). A retrospective study was conducted, and clinical data, tumor characteristics, and oncologic outcomes were acquired and analyzed. Results. Renal cancer was the primary site of malignancy in 44.4% of cases. The mean operative time was 132 ± 10.4 min. There were 5 synchronous and 4 metachronous AM. One patient required conversion to transperitoneal laparoscopic procedure. No mortality or perioperative complications were observed. The median overall survival was 11 months (range: 2-42 months). Survival rates of 50% and 25% were identified at 1 and 3 years, respectively. At the end of the study, 4 patients were alive with a mean observed follow-up of 20 months. No patients presented with local tumor relapse or port-site metastases. Conclusions. This study shows that ERA is a safe and effective procedure for resection of AM and advances the surgical treatment of adrenal disease. The use of the retroperitoneal approach for adrenal tumors less than 6 cm can provide very favorable surgical outcomes.
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Affiliation(s)
- Gintaras Simutis
- Clinic of Gastroenterology, Nephrourology and Surgery, Center of Abdominal Surgery, Faculty of Medicine, Vilnius University, Santariškiu 2, 08661 Vilnius, Lithuania
- *Gintaras Simutis:
| | - Givi Lengvenis
- Faculty of Medicine, Vilnius University, M.K.Čiulionio 21, 03101 Vilnius, Lithuania
| | - Virgilijus Beiša
- Clinic of Gastroenterology, Nephrourology and Surgery, Center of Abdominal Surgery, Faculty of Medicine, Vilnius University, Santariškiu 2, 08661 Vilnius, Lithuania
| | - Kęstutis Strupas
- Clinic of Gastroenterology, Nephrourology and Surgery, Center of Abdominal Surgery, Faculty of Medicine, Vilnius University, Santariškiu 2, 08661 Vilnius, Lithuania
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