Laparoscopic adrenalectomy for metastatic disease: Retrospective cohort with long-term, comprehensive follow-up

Drake, Frederick Thurston; Beninato, Toni; Xiong, Maggie; Shah, Nirav V; Kluijfhout, Wouter P.; Feeney, Timothy; Suh, Insoo; Gosnell, Jessica E.; Shen, Wen T.; Duh, Quan‐Yang

doi:10.1016/j.surg.2018.11.008

Cited by 16 publications

(12 citation statements)

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“…Two recently published prospective phase II studies demonstrate that the addition of local ablative treatment to standard of care palliative therapy for oligometastatic tumor patients not only prolonged progression-free survival (PFS), but also overall survival (OS) [10,11]. Additionally, some surgical series report superior outcomes following adrenalectomy in selected patients with isolated adrenal gland metastases [12][13][14][15]. However, many patients with adrenal gland metastases are considered medically inoperable due to severe comorbidities or the location or the extent of their metastases [16].…”

Section: Introductionmentioning

confidence: 99%

Stereotactic body radiotherapy (SBRT) for adrenal metastases of oligometastatic or oligoprogressive tumor patients

et al. 2020

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Introduction: Local ablative treatment strategies are frequently offered to patients diagnosed with oligometastatic disease. Stereotactic body radiotherapy (SBRT), as ablative treatment option, is well established for lung and liver metastases, whereas for isolated adrenal gland metastases the level of evidence is scarce. Material and methods: This single-institution analysis of oligometastatic or oligoprogressive disease was limited to patients who received SBRT to adrenal metastasis between 2012 and 2019. Patient, tumor, treatment characteristics, and dosimetric parameters were analyzed for evaluation of their effect on survival outcomes. Results: During the period of review 28 patients received ablative SBRT to their adrenal gland metastases. Most common primary tumors were non-small cell lung cancers (46%) with most patients diagnosed with a single adrenal gland metastasis (61%), which occurred after a median time of 14 months. SBRT was delivered to a median biological effective dose at α/β of 10 (BED 10) of 75 Gy (range: 58-151 Gy). Median gross tumor volume (GTV) and median planning target volume (PTV) were 42 and 111 mL, respectively. The homogeneity and conformity indices were 1.17 (range: 1.04-1.64) and 0.5 (range: 0.4.0.99), respectively, with the conformity index being affected by dose restrictions to organs at risk (OARs) in 50% of the patients. Overall response rate based on RECIST criteria was 86% (CR = 29%, PR = 57%) with 2-year local control (LC) of 84.8%, 2-year progression-free survival (PFS) of 26.3%, and 1and 2-year overall survival (OS) of 46.6 and 32.0%, respectively. During follow up, only two local recurrences occurred. A trend for superior LC was seen if BED 10 was ≥75Gy (p = 0.101) or if the PTV was < 100 ml (p = 0.072). SBRT was tolerated well with only mild toxicity. Conclusion: SBRT for adrenal metastases resulted in promising LC with low toxicity. Treatment response appeared to be superior, if SBRT was applied with higher BED. As the close proximity of OARs often limits the application of sufficiently high doses, further dose escalations strategies and techniques should be investigated in future.

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Section: Introductionmentioning

confidence: 99%

Stereotactic body radiotherapy (SBRT) for adrenal metastases of oligometastatic or oligoprogressive tumor patients

et al. 2020

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“…Lung cancer as the origin of the metastasis seems to be concordant with the literature. However, colorectal cancer has not previously been described as one of the most common origins [ 23 , 24 , 25 , 26 ]. A possible reason for the found percentage of primary colorectal cancers could be explained by the fact that the Netherlands has one of the highest incidences of colorectal cancer worldwide [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…Only 21 patients underwent adrenalectomy [ 29 ]. In another large cohort of patients undergoing adrenalectomy for metastatic disease, 63% of the patients were diagnosed with metachronous metastatic disease [ 26 ]. Studies showed conflicting data regarding the laterality of adrenal metastasis.…”

Section: Discussionmentioning

confidence: 99%

Outcomes after Surgical Treatment of Metastatic Disease in the Adrenal Gland; Valuable for the Patient?

Metman

Viëtor

Seinen

et al. 2021

Cancers

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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.

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“…Three of the patients in this study suffered from metastatic lesions of the adrenal gland after lung cancer treatment and received this surgery for excision, which was found to have had good long-lasting results via 6-month follow-up. Drake et al 21 included 62 patients with metastatic tumors of the adrenal gland to conduct adrenal gland excision from 1995 to 2016, and 59 of them (95%) received laparoscopy surgery. The study endpoint was the five-year survival rate and median survival time.…”

Section: Discussionmentioning

confidence: 99%

Experience in the application of laparoscopic anatomical adrenalectomy via the renal cortex surface monolayer

Ma¹,

Yang²,

Cui³

et al. 2020

Pak J Med Sci

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Objective: To discuss the clinical application of laparoscopic anatomical adrenalectomy via the renal cortex surface in the operation of adrenal masses. Methods: A retrospective analysis was performed on 231 patients with adrenal masses who were received and cured in the urology department of the Affiliated Hospital of Hebei University from July 2016 to January 2019. All patients received retroperitoneal adrenalectomy by means of laparoscopic anatomical adrenalectomy via the renal cortex surface. Operation duration, bleeding volume, postoperative complications, retention time of the drainage tube were measured and analyzed, and postoperative follow-up surveys were administered. Results: All cases were successfully operated. Two cases were converted to open surgery due to the presence of large adrenal tumors, and the patients suffered no significant complications. The mean operation duration, bleeding volume and retention time of the drainage tube were 31 minutes, 20 mL and 1.2±0.6 d, respectively. In terms of the postoperative pathology of adrenal tumors, 183 cases were shown to have adenomas, 34 had pheochromocytomas, nine had schwannomas, 3 had metastases from lung cancer, and two had sarcomas. A total of 174 patients were followed up for three to 18 months. Only one case with sarcoma that relapsed within half a year of the operation. Conclusion: In the treatment of adrenal masses, laparoscopic anatomical adrenalectomy via the renal cortex surface has many advantages including the large operation space, clear view of anatomical markers, little bleeding, small trauma, few postoperative complications, simple operational procedures and short learning curves. This technique needs clinical promotion. doi: https://doi.org/10.12669/pjms.36.4.2102 How to cite this:Ma T, Yang W, Cui Z, Zhao C. Experience in the application of laparoscopic anatomical adrenalectomy via the renal cortex surface monolayer. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.2102 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Laparoscopic adrenalectomy for metastatic disease: Retrospective cohort with long-term, comprehensive follow-up

Cited by 16 publications

References 12 publications

Stereotactic body radiotherapy (SBRT) for adrenal metastases of oligometastatic or oligoprogressive tumor patients

Stereotactic body radiotherapy (SBRT) for adrenal metastases of oligometastatic or oligoprogressive tumor patients

Outcomes after Surgical Treatment of Metastatic Disease in the Adrenal Gland; Valuable for the Patient?

Experience in the application of laparoscopic anatomical adrenalectomy via the renal cortex surface monolayer

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