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

Abstract

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.

Risk factors of local control in adrenal metastases treated by stereotactic body radiation therapy - a systematic review and meta-analysis

“…The median follow-up was 13.4 months, ranging from 0 to 124 months, and the median OS was 19 months, ranging from 0.4 to 171 months. The median total dose was 36Gy(10-70Gy) and the median number of fraction was 4.5 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). The median dose per fraction was 7.5Gy, ranging from 2 to 30Gy, and the median BED10 was 71.4Gy, ranging from 20 to 180Gy.…”

“…Targeted local therapies are gaining popularity as ablative therapy may improve outcomes in patients with limited systemic disease burden (1,2). A paired analysis of 62 patients with isolated AM found that SBRT and laparoscopic adrenalectomy had similar outcomes and survival rates (4), but complications occurred in 37.9% of patients, including ileus or gastroparesis, wound problems, pneumonia, and heart arrhythmia (5). Stereotactic body radiation therapy (SBRT) enables conformal delivery of ablative radiation doses using single or a small number of fractions, resulting in a more effective radio biologic dose (6).…”