[Carcinological results of laparoscopic adrenalectomy for adrenal metastasis]

Introduction and objectives: Indication of laparoscopic adrenalectomy for adrenal metastasis remains debated. Our aim was to analyze its carcinological results.

Material and methods: In a series of 332 laparoscopic adrenalectomies, 13 were for adrenal metastasis (kidney=5, lung=3, melanoma=3, breast=1, eye=1). The indication was curative (single metastasis) in nine cases (69%), the four other patients (31%) having a polymetastatic disease. All alive patients were interviewed in August 2010. Survival was estimated using the Kaplan-Meyer method, with comparisons using the log rank test.

Results: Mean operative time was 174.2 ± 102 minutes. Blood loss was 351 ± 136 mL. Three conversions (23%) were necessary, for gastric perforation, wound of vena cava and inability to dissect the adrenal. Surgical margins were positive in six cases (46%). The risk of positive margin was lower in case of metastasis of renal cell carcinoma (Fischer, p=0.02). The median of overall survival was 14 months (3-45). Survival was significantly higher in metastases of renal cell carcinoma (p=0.035) than in metastases of other tumors, 24 months (11-36) vs six months (3-45), respectively. There was no difference according to the laparoscopic technique used, neither according to the age, nor according to the tumoral size.

Conclusions: Laparoscopic surgery did not offer sufficient guarantee to be considered as the standard treatment in case of adrenal metastasis. However, with a survival rate of 60%, a lower rate of surgical margins, metastases of renal cell carcinoma seem to be the better candidates for laparoscopic adrenalectomy.