Carcinological results of laparoscopic adrenalectomy for adrenal metastasis

Indication of laparoscopic adrenalectomy for adrenal metastasis remains debated. Our aim was to analyze its carcinological results. In a series of 332 laparoscopic adrenalectomies, 13 were for adrenal metastasis (kidney=5, lung=3, melanoma=3, breast=1, eye=1). The indication was curative (single metastasis) in nine cases (69%), the four other patients (31%) having a polymetastatic disease. All alive patients were interviewed in August 2010. Survival was estimated using the Kaplan-Meyer method, with comparisons using the log rank test. Mean operative time was 174.2 ± 102 minutes. Blood loss was 351 ± 136 mL. Three conversions (23%) were necessary, for gastric perforation, wound of vena cava and inability to dissect the adrenal. Surgical margins were positive in six cases (46%). The risk of positive margin was lower in case of metastasis of renal cell carcinoma (Fischer, p=0.02). The median of overall survival was 14 months (3-45). Survival was significantly higher in metastases of renal cell carcinoma (p=0.035) than in metastases of other tumors, 24 months (11-36) vs six months (3-45), respectively. There was no difference according to the laparoscopic technique used, neither according to the age, nor according to the tumoral size. Laparoscopic surgery did not offer sufficient guarantee to be considered as the standard treatment in case of adrenal metastasis. However, with a survival rate of 60%, a lower rate of surgical margins, metastases of renal cell carcinoma seem to be the better candidates for laparoscopic adrenalectomy.