P169: Equal oncologic outcomes for adrenal metastases with laparoscopic and open resection

Abstract

Background: Cancerous lesions of the adrenal gland have typically been treated by an open adrenalectomy. Only recently has laparoscopic adrenalectomy been used to remove metastases less than 10 cm that do not invade surrounding tissue. Although short-term benefits of laparoscopic adrenalectomy are well established, questions persist about its long-term outcomes. This study was intended to compare surgical and oncologic outcomes of laparoscopic with open adrenalectomy in patients with isolated adrenal metastases. Methods: From March 1993 to April 2006, 143 patients underwent adrenalectomy at a single institution. Of these, 20 adults had metastases to the adrenal gland. 2 patients were excluded due to a concomitant nephrectomy, and 1 was excluded because the tumor was unresectable. Surgical and oncologic outcomes of 17 patients with isolated metastases to the adrenal gland were retrospectively measured and analyzed. Results: There were 11 men and 6 women with a mean age of 58±3 years. The most common origins of metastases were renal cell carcinoma (n = 6), non-small cell lung cancer (n = 5), and melanoma (n = 2). 9 patients underwent laparoscopic, while 8 patients had open adrenalectomy. Laparoscopic adrenalectomy was associated with less blood loss (63±8 ml vs. 2207±1067 ml, p = 0.05, mean±SE), fewer complications (0% vs. 62.5%, p = 0.009, Fisher’s exact test), and a shorter length of stay (2.4±0.6 d vs. 5.4±0.7 d, p = 0.02). With a follow-up of up to 97 months, there were neither port site metastases nor recurrences in either group. The 5-year actuarial survival for all patients was 46.8% (median 19 mo). There was no difference in survival found between laparoscopic and open adrenalectomy (5-year actuarial 34% vs. 54%, median 19 mo vs. 17 mo, p = 0.96, log rank test). Conclusions: Laparoscopic adrenalectomy in patients with isolated metastases to the adrenal gland appears to have improved surgical outcomes compared to open resection. More importantly, the lack of recurrence and similar 5-year survival in each group suggests equal oncologic results for both approaches. When not limited by tumor size or invasion of surrounding tissue, laparoscopic adrenalectomy appears to be a safe alternative with clear surgical benefit for patients with isolated adrenal metastases.