Adrenalectomy for isolated adrenal metastases from non-adrenal cancer

Adrenalectomy for metastatic cancer is rarely performed. The survival benefit for patients undergoing resection of isolated adrenal metastases is not clear. The goal of this study was to compile a series of such cases from national and international sources and examine patient survival. The patient series was derived from published series and case reports, plus eight new cases from an international registry of patients. We found 77 patients. We examined the effect of primary tumor site, metastasis size, and disease-free interval on postoperative survival duration, including only cases where complete resection with negative margins was achieved. We compared these patients with a large series from Memorial Sloan-Kettering Cancer Center (N=37). The median survival time after adrenalectomy was 23 months, with an operative mortality rate of 3.9%. There was a significant difference in survival duration depending on primary tumor site. A longer disease-free interval from time of primary cancer therapy to adrenal metastasis was associated with a longer postoperative survival after adrenalectomy. Metastasis size did not affect survival. Survival times for USA and non-USA patients were similar. Survival duration of the 77 analytical patients was similar to that of the 37 non-analytical patients from Memorial Sloan-Kettering Cancer Center. Selected patients, particularly those with long disease-free intervals and favorable tumor biology, should be offered resection for isolated adrenal metastases.