Adrenalectomy for Isolated Metastases

Abstract

Background: Isolated adrenal gland metastases are not frequently finding. The aim of the present retrospective study was to estimate clinical and pathological parameters that could be used to predict survival after adrenalectomy.Material and methods: A total of 34 patients with adrenal gland masses suspected to be metastases was included in this study. The group of patients with isolated metastases was19 (56%) and a group of patients with adrenal adenomas -15 (44%).Results: The sample of patients consisted of 18 (53%) men and 16 (47%) women from 40 to 81 years old with a mean (±SD) age of 61.6±10.3 years, presented with adrenal mass suspected to be metastases. Nineteen (56%) of them had demonstrated metastases and 16 (84%) metachronous with median overall survival (OS) 54.6 (range 43-66) months. Median OS in the group with metastases was 22.6 months. Lung carcinoma was the most common primary tumour metastasizing in the adrenal gland -58% of all metastases with a disease-free interval (DFI) of 13 months. It was presented by shorter median survival than the rest primary tumour types (37.8 vs. 96.7months; logrank test, p=0.028). In the multivariate Cox's hazard analysis of the surgical technique was found to be an independent prognostic factor (p=0.047), together with lung carcinoma vs. renal cell carcinoma (p=0.045).Conclusion: Adrenalectomy due to isolated metastases in the adrenal glands showed the median overall survival of 22.6 months. Shorter survival periods were associated with lung carcinoma, DFI<12months, conversion to open surgery, synchronous metastases, but not with age, tumour size or resection status.

Management of an Unusual Metastasis of Cervical Cancer in the Adrenal Bed With Stereotactic Ablative Body Radiation Therapy

“…The most common primary tumors that spread to the adrenal glands are from the lungs, breasts, gastrointestinal system, and skin (melanomas) [20]. As mentioned earlier, adrenal metastasis from a primary cervix carcinoma is rare, and the case reports found in the literature are scarce; there is a cohort study with 34 patients that shows, however, an incidence of 6% of cervix carcinoma spreading to an adrenal metastasis [7]. In addition to adrenal metastasis being unlikely in cervix carcinoma, our patient had previous adrenalectomy, and the metastasis was in the adrenal bed [20].…”

“…The benefit of this surgery is however disputed, the outcomes depend on the kind of surgical technique used and the primary tumor site. The identification of patients that could benefit from a surgical resection is still difficult, but the survival rate difference between open surgery and laparoscopy is not significant [6][7][8].…”

Adrenal gland as a target of synchronous and metacronous metastasis from renal cell carcinoma: results of surgical treatment in a single institution

“…Р.Латыповаисоавт.оценива-лирезультатыхирургическоголечения16пациентов ссолитарнымиметахроннымиметастазамивнадпочечниках.Среднеевремядореализацииметаста-завнадпочечникесоставило27,3мес,5-летняявыживаемость-47,8 %[12]. Прихирургическомлеченииметастатических опухолейнадпочечниковблагоприятнымифакторами,поданнымразныхавторов,являютсянали-чиеПКРиколоректальногорака(посравнению сНМРЛимеланомой),отсутствиеэкстраадреналовыхметастазовипредыдущихметастазэктомий, размеропухоли<4,5см,выраженностьсистемной воспалительнойреакции(уровниC-реактивного белка>1,0мг / длиальбумина>3,5мг / дл;p=0,002) [13][14][15].B.J.Vazquezисоавт.отметилитакиефакторынеблагоприятногопрогноза,какпоражение надпочечника<24месотмоментапостановкидиагнозапервичнойопухоли,локализацияпервичной опухоли в поджелудочной железе, размеры метастаза,другиеотдаленныеочаги(p<0,05) [16]. Прианализеполученныхнамиданныхметахронное поражение надпочечника ( p <0,0001), время реализацииметастаза≥24мес(p =0,007)являлись благоприятными факторами прогноза, однако примногофакторноманализетолькометахронное поражениеявилосьфакторомблагоприятногопрогноза(p=0,002).…”

Surgical Treatment of Solitary Metachronous Adrenal Metastasis from Urothelial Carcinoma of the Urinary Bladder

“…The adrenal glands are the fourth most common metastatic site for all cancers after the lung, liver and bone. 11 , 12 Synchronous, bilateral adrenal metastases are rare (<0.5%), 11 – 14 except with lymphomas, where the prevalence of bilateral adrenal involvement reaches 71%. 15 , 16 The abundant sinusoidal blood supply of the adrenal glands and the possible communication between the pulmonary and retroperitoneal lymphatic pathways have been postulated to facilitate the metastatic process.…”

“… 15 , 16 The abundant sinusoidal blood supply of the adrenal glands and the possible communication between the pulmonary and retroperitoneal lymphatic pathways have been postulated to facilitate the metastatic process. 12 However, such a supply is present in the spleen, which is seldom a site of metastasis. 17 Metastases occur usually at the border between the adrenal cortex and medulla.…”