A multi‐center study on the surgical management of metastatic disease to adrenal glands

Valeri, Andrea; Bergamini, Carlo; Tozzi, Fabiano; Martellucci, Jacopo; Costanzo, Francesco Di; Antonuzzo, Lorenzo

doi:10.1002/jso.21843

Cited by 18 publications

(14 citation statements)

References 32 publications

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“…This is corroborated by some, but not by others. 14–15, 18–19 One potential theory that may partially explain the discordance relates to the pathophysiology of lung cancer spread to the adrenal glands. The lymphatic drainage between the lung and retroperitoneum has been well described and it is postulated by some that ipsilateral isolated adrenal metastasis may occur through this mechanism, and thus represent a less aggressive form of regional spread.…”

Section: Discussionmentioning

confidence: 99%

Outcome and Prognostic Factors After Adrenalectomy for Patients with Distant Adrenal Metastasis

et al. 2013

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Purpose To describe a single institution experience with adrenal metastasectomy, and to elucidate factors that may bear prognostic significance. Methods Single center, retrospective review of patients with adrenal metastasis who underwent adrenalectomy performed with curative intent between 2000–2012. Kaplan-Meier method was utilized to evaluate overall survival from time of adrenalectomy to death or last follow-up. Primary endpoint was death from any cause. Clinical variables were examined for association with survival. Results Study included 62 patients with mean age of 60 (± 12) years. 55% (34/62) were male, 85% (53/62) presented with isolated adrenal metastasis, and 82% (51/62) had metachronous disease with median DFI of 22 months (range 6–217). Non-small cell lung cancer (NSCLC) was the most common primary comprising 50% of cases. Median survival for the study population was 30 months (range 1–145) and 5-year survival was 31%. Patients with NSCLC had significantly shortened survival compared to non-NSCLC with median and 5-yr survival of 17 vs. 47 months and 27% vs. 38%, respectively (p=0.033). Synchronous metastasis (p=0.028) and DFI <12 months (p=0.038) were also associated with worse survival outcome, though male gender (p=0.69) and oligometastatic disease (p=0.62) were not. Conclusion Adrenal metastasectomy resulted in median survival of 30 months and 5-year survival of 31%. Shorter survival was associated with lung primary, short disease-free interval, and synchronous metastasis, but not with the presence of oligometastatic disease provided that the primary cancer and additional metastatic lesions were adequately controlled and amenable to resection.

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Section: Discussionmentioning

confidence: 99%

Outcome and Prognostic Factors After Adrenalectomy for Patients with Distant Adrenal Metastasis

et al. 2013

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“…[22] Reported outcomes are better with adrenalectomy and radiation therapy (16 – 31 months) than medically treated metastatic disease (9–12 months. )[10, 18–20, 22, 23, 29, 30, 32] If involvement of the ipsilateral adrenal gland is lymphatic in origin, one should see improvement in survival if the adrenal metastasis is managed aggressively with surgery and radiation similar to an improved survival seen in patients with stage III disease compared to patients with stage IV disease. The main challenge in looking at this question is that studies reporting outcomes of aggressively managed isolated adrenal metastases fail to report outcomes based on laterality.…”

Section: Lymphatic Theory Of Adrenal Gland Metastasis In Primary Lungmentioning

confidence: 99%

Adrenal Metastases in Lung Cancer: Clinical Implications of a Mathematical Model

Bazhenova

Newton

Mason

et al. 2014

Journal of Thoracic Oncology

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Adrenal gland metastases are common in lung cancer. It is well recognized that aggressive treatment of solitary adrenal metastases leads to improved outcomes but the exact nature of adrenal deposits is not well understood. Controversy exists as to the routing of cancer cells to the adrenal gland with some believing that this transmission is lymphatic, in contrast to the more generally accepted theory of hematogenous spread. Recently published mathematical modeling of cancer progression strongly supports the lymphatic theory. With that in mind we performed a literature review to look for biological plausibility of simulation results and believe that evidence supports the contention that metastases to the adrenal gland can be routed via lymphatic channels. This could explain improved survival for patients in whom solitary adrenal metastases are managed aggressively with surgical or radiation modalities. We are calling for clinical trials prospectively testing this hypothesis.

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“…Factors to consider when selecting patients for adrenalectomy include: (1) whether control of extra-adrenal disease is achieved and the metastasis is isolated to the adrenal gland, (2) has biochemical evaluation been performed and appropriately addressed, (3) has the patient either an adrenal image highly suggestive of metastasis or a biopsy-proven adrenal metastasis that appears resectable on imaging studies, and (4) whether the patient's performance status warrants a surgical approach [6,58,[66][67][68][69][70].…”

Section: Indicationsmentioning

confidence: 99%

Surgical management of adrenal metastases

Sancho

Triponez

Montet

et al. 2011

Langenbecks Arch Surg

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A patient with suspected adrenal metastasis should be considered a candidate for adrenalectomy when: (a) control of extra-adrenal disease can be accomplished, (b) metastasis is isolated to the adrenal gland(s), (c) adrenal imaging is highly suggestive of metastasis or the patient has a biopsy-proven adrenal malignancy, (d) metastasis is confined to the adrenal gland as assessed by a recent imaging study, and (e) the patient's performance status warrants an aggressive approach. In properly selected patients, laparoscopic (or retroperitoneoscopic) adrenalectomy is a feasible and safe option.

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A multi‐center study on the surgical management of metastatic disease to adrenal glands

Abstract: Laparoscopy for AM, in expert hand, seems to be a feasible and oncologically safe approach. Due to the unsatisfactory diagnostic accuracy for AM, every oncological patient with suspect adrenal lesions should be encouraged to undergo this surgical procedure.

Cited by 18 publications

References 32 publications

Outcome and Prognostic Factors After Adrenalectomy for Patients with Distant Adrenal Metastasis

Outcome and Prognostic Factors After Adrenalectomy for Patients with Distant Adrenal Metastasis

Adrenal Metastases in Lung Cancer: Clinical Implications of a Mathematical Model

Surgical management of adrenal metastases

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