Surgical resection of adrenal metastasis from colorectal cancers: a systematic review

BACKGROUND

The decision for resection of adrenal metastasis from colorectal cancers remain controversial and there is no proposed standard treatment. The aim of the article is to review the available literature on outcomes and complications rates following adrenalectomy for adrenal metastasis from colorectal cancer.

METHODS

Relevant papers were identified through electronic databases. Data was extracted independently by two authors on a Microsoft Excel spreadsheet up to June 2023.

RESULTS

A total of 55 studies were included in the final analysis (145 cases). A large proportion of patients had an uneventful postoperative recovery following surgical adrenalectomy. The mean length of follow up ranged from 2 months to 9.5 years. A total of 33 (22.8%) patients were alive and well with no evidence of local or systemic recurrence; 2 (1.4%) patients had recurrence in the bed of adrenalectomy; 2 (1.4%) patients were alive with recurrence in the contralateral adrenal gland; 4 (2.8%) patients were alive with extra-adrenal metastasis, and 7 (4.8%) patients were alive and well with no comments regarding local and systemic recurrence. Post-operative mortality following adrenalectomy was uncommon: 1 patient died due to systemic sepsis following anastomotic leak. 17.2% of patients died due to disease progression.

CONCLUSION

If complete resection can be achieved, surgical adrenalectomy in the surgically fit patient should be strongly considered, especially in patients with solitary adrenal metastasis which may translate into survival benefits and potential surgical cure.

Long-term Disease-free Survival After Adrenalectomy for Isolated Colorectal Metastases

Metastasis to the adrenal glands occurs in approximately 16% of patients with metastatic colorectal carcinoma. Historically, these metastases are found at autopsy, but due to improved imaging and diagnostic techniques, many of these lesions are now discovered on routine follow-up imaging. In general, adrenal metastasis is an indicator of widespread disease, but in rare cases, isolated adrenal metastasis can be found. Although potential improvement in overall survival after adrenalectomy for isolated colorectal metastases has been reported, there has only been one long-term disease-free survivor reported. Here, we report a patient who is a 7-year disease-free survivor after adrenalectomy for an isolated colorectal metastasis.