Should we use laparoscopic adrenalectomy for metastases? Scandinavian multicenter study

Marangos, Irina Pavlik; Kazaryan, Airazat M.; Rosseland, Arne R.; Røsok, Bård I.; Carlsen, Hege S.; Kromann‐Andersen, Bjarne; Brennhovd, Bjørn; Hauss, Hans J.; Giercksky, Karl Erik; Mathisen, Øystein; Edwin, Bjørn

doi:10.1002/jso.21293

Cited by 50 publications

(57 citation statements)

References 34 publications

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“…For example, a previous study claims that adrenalectomy has not proven beneficial in the treatment of patients with adrenal metastases following resection of colorectal hepatic metastases (26). However, other studies argued that laparoscopic adrenalectomy had its advantages compared to traditional open surgery, and improved the survival of patients with adrenal metastases (27). In the present study, laparoscopic adrenalectomy was found to be beneficial; however, the survival of patients with laparoscopic adrenalectomy did not appear to be different from that of patients with open surgery (data not shown).…”

Section: Discussionmentioning

confidence: 99%

Adrenalectomy may increase survival of patients with adrenal metastases

Zheng

Zhang

et al. 2012

Oncol Lett

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Abstract. The much improved diagnostic accuracy of computed tomography (CT) and positron emission tomography (PET) has enabled urologists and medical oncologists to identify and treat more patients with metastases to the adrenal glands. The aim of this retrospective study was to analyze the clinical aspects of adrenal metastases in a series of patients and to evaluate the effect of adrenalectomy, by laparoscopic or open resection of adrenal metastases, on the survival of these patients. A total of 47 patients (32 males, 15 females) with metastatic disease in the adrenal glands were included in this study. Type B ultrasound and CT were utilized to diagnose the adrenal metastases. Open resection was performed in certain patients with primary tumor and adrenal metastasis. The results showed that adrenal metastases in these patients had various origins, including lung carcinoma, kidney carcinoma, breast cancer, melanoma and other uncharacterized carcinomas. The median survival of the 37 followed-up patients was 29.7±3.23 months (range, 2-62) after the diagnosis/surgical removal of adrenal metastases. The survival rate of the 31 patients with surgically removed adrenal metastases (average, 34.2±4.7 months; range 2-62) was higher than the survival rates of the 6 patients without surgical resection (average, 6.3±2.7 months; range, 4-8). The results of this study are in support of adrenalectomy for patients with adrenal metastases.

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Section: Discussionmentioning

confidence: 99%

Adrenalectomy may increase survival of patients with adrenal metastases

Zheng

Zhang

et al. 2012

Oncol Lett

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“…However, the introduction of laparoscopy has rendered surgery the primary treating modality of adrenal metastases. Laparoscopic approach has been proven to be as effective as open surgery [4,25], with the former associated with less blood loss (63±8 mL versus 2,207±1,067 mL, P00.05), a lower complication rate (0% versus 63%, P0 0.009), and a shorter length of stay [26]. Contraindications to laparoscopic surgery include pregnancy, large tumors (>8 cm), or suspicion of primary invasive adrenocortical carcinoma on imaging.…”

Section: Surgerymentioning

confidence: 99%

“…Surgical complication rate ranged between 4% and 29.4% [26,27,29,30]. Complications include deep venous thrombosis, pulmonary embolism, stroke, pneumonia, hematoma, myocardiac infarction, atelectasis, bowel perforation, lung infection, and wound infection [25,27,31]. Recurrence rate was reported to be between 0-21% [26,30], and the 5-year survival between 22.5% and 47% [4,26].…”

Section: Surgerymentioning

confidence: 99%

Diagnosis and treatment options including stereotactic body radiation therapy (SBRT) for adrenal metastases

Eldaya

Paulino

et al. 2012

J Radiat Oncol

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Adrenal metastasis is common in oncology but patients with this diagnosis are usually asymptomatic. The diagnosis can be challenging and delayed. Incidence, presenting symptoms and diagnostic modalities are reviewed. Various treatment options are also discussed, including open and laparoscopic surgery, local ablation (radiofrequency ablation, cryoablation, microwave thermal ablation, and chemical ablation) as well as radiation therapy. These treatment modalities were compared and contrasted in regards to their invasiveness, risks, side effects, outcomes, and patients' tolerance. Radiotherapy including stereotactic body radiation therapy (SBRT) is the only non-invasive approach, which is important as majority of the patients with adrenal metastases also receive systemic therapy, e.g., chemotherapy. The initial goal of conventional radiotherapy for metastatic adrenal lesion is for palliation which has been shown to be effective. With the advent of technological advances in radiation oncology, e.g., imageguidance during radiation delivery, patient immobilization and patient re-positioning, tumor motion management, sophisticated treatment planning allowing rapid dose fall-off, accurate QA, etc., the clinical implementation of SBRT has been very successful. SBRT is defined as a "treatment method to deliver high dose of radiation to the target, utilizing either a single dose or a small number of fractions with a high degree of precision within the body". Adrenal metastasis, an example of oligometastases even from radioresistant primary, could be successfully treated with SBRT without significant toxicity as evidenced by various recently reported clinical trials. An additional advantage could be adrenal function preservation when compared to surgical intervention. The optimal total dose and fractionation scheme are yet to be determined. SBRT is an emerging non-invasive, safe, and effective treatment modality, and further research is warranted to define its role in the management of adrenal metastasis.

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“…However, bilateral LA is effective for bilateral adrenal hyperplasia, neoplasmas or Cushing's syndrome (Fernández-Cruz et al 1996). The role of LA in patients with large adrenal lesions (> 6 cm), or potential malignancy remains controversial (Sturgeon and kebebew 2004;Cobb et al 2005;Tsuru et al 2005 ;Ramacciato et al 2008;Toniato et al 2007;Eto et al 2008;Marangos et al 2009). Pheochromocytoma is no longer considered a contraindication for LA, provided the appropriate drug treatment is carried out before surgery (alpha followed by beta-receptor or calcium channel blockers) (Toniato et al 2007;Humphrey et al 2008).…”

Section: Indicationsmentioning

confidence: 99%

“…Pheochromocytoma is no longer considered a contraindication for LA, provided the appropriate drug treatment is carried out before surgery (alpha followed by beta-receptor or calcium channel blockers) (Toniato et al 2007;Humphrey et al 2008). The effectiveness of LA for adrenocortical carcinoma and metastatic adrenal disease remains debatable (Gagner et al 1997;Fazeli-Matin et al 1999;Sturgeon and Kebebew 2004;Cobb et al 2005;Tsuru et al 2005;Eto et al 2008;Choh and Madura 2009;Marangos et al 2009;Turner et al 2009). When operating the adrenals for malignancy, the most important concern is whether the laparoscopic resection can achieve an equal oncological result in comparison with open surgery, the long-term survival and the risk of topical recurrence.…”

Section: Indicationsmentioning

confidence: 99%