Abstract
Simple SummaryAdrenal glands are common dissemination sites for metastases of various solid tumors. The rapid development of new treatment strategies, such as targeted therapy and immunotherapy for different cancer types, has led to increased metastatic adrenalectomies. Therefore, clear communication between oncologists and adrenal gland specialists has become increasingly important to outweigh surgical risks versus oncological advantages of adrenalectomies in these patients. This study assesses trends in diagnosis, type of surgery, and short-term and long-term surgical outcomes of patients who underwent metastatic adrenalectomy. We included a total of 95 patients with an adrenal metastasis of non-adrenal primary tumors, most often colorectal or lung cancer, who underwent (minimal invasive) adrenalectomy. 37.9% of the patients experienced one or more complications after adrenalectomy. Within our patient cohort, an increased demand for metastatic adrenalectomy was observed over the past years, which might be associated with the rise of targeted- and immunotherapy. Our data aims to assist multidisciplinary teams with weighing the pros and cons of resection of the metastasized adrenal gland of cancer patients.The adrenal glands are common dissemination sites for metastasis of various solid tumors. Surgical treatment is often recommended because targeted therapies and immunotherapy are frequently ineffective for adrenal metastasis. We report the experience with short-term and long-term surgical outcomes of patients undergoing surgery for adrenal metastasis in two hospitals. A retrospective, multicenter study was performed to analyze patient characteristics, tumor-related data, perioperative outcomes, and oncological outcomes. Postoperative complications that occurred within 30 days were scored according to the Clavien Dindo classification. Metastatic adrenalectomy was performed in 95 patients. We observed an increase from an average of 3 metastatic adrenalectomies per year between 2001–2005 to 10 between 2015–2019. The most frequent underlying malignancies were colorectal and lung cancer. In 55.8%, minimal invasive adrenalectomy was performed, including six conversions to open surgery. A total of 37.9% of patients had postoperative complications, of which ileus or gastroparesis, wound problems, pneumonia, and heart arrhythmias were the most occurring complications. Improved cancer care has led to an increased demand for metastatic adrenalectomy over the past years. Complication rates of 37.9% are significant and cannot be neglected. Therefore, multidisciplinary teams should weigh the decision to perform metastatic adrenalectomy for each patient individually, taking into account the drawbacks of the described morbidity versus the potential benefits.
Highlights
Due to a rich blood supply [1], the adrenal glands are common dissemination sites for cancer metastases of various solid tumors of different tumor entities [2]
Surgical techniques have improved in the last decades by introducing minimally invasive techniques such as lateral transperitoneal adrenalectomy (LTA) and retroperitoneoscopic posterior adrenalectomy (RPA)
We included a total of 95 patients who underwent metastatic adrenalectomy, of which 20 patients with synchronous metastasis and 75 with metachronous metastasis
Summary
Due to a rich blood supply [1], the adrenal glands are common dissemination sites for cancer metastases of various solid tumors of different tumor entities [2]. Adrenal metastases are increasingly detected due to better-quality imaging techniques, standardized routine imaging follow-up [6], and improved cancer care over the years, including better treatment strategies with prolonged overall survival. Surgical techniques have improved in the last decades by introducing minimally invasive techniques such as lateral transperitoneal adrenalectomy (LTA) and retroperitoneoscopic posterior adrenalectomy (RPA). These approaches have proven feasible and safe and are associated with less morbidity than open adrenalectomy [2,15,16,17,18,19,20] while preserving equal oncological outcomes [18,20]
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