[Laparoscopic adrenalectomy for suspected isolated adrenal metastasis]

Isolated adrenal metastasis is uncommon. Both resection and the laparoscopic approach in this entity are controversial. The aim of this study was to evaluate the indications, diagnosis and utility of laparoscopic adrenalectomy (LA) in patients with isolated adrenal metastasis.

A prospective study was conducted in patients with current or previous tumoral disease and with isolated adrenal metastasis.

Sixteen patients, with a mean age of 58 years, were selected. Fifteen LA were performed (one patient was found to have an inoperable tumor at surgery). Histopathological analysis revealed non-tumoral disease in two patients. The most common metastatic disease was non-small cell lung carcinoma (NSCLC) (10 patients), followed by colorectal cancer metastasis (two patients). The mean tumor size was 4.7 cm and was 3.8 cm on computed tomography (p = 0.09). The disease-free interval (DFI) in the NSCLC group was shorter than that in the remaining tumors (p = 0.17). The mean length of follow-up was 39 months, with a mean survival of 39.7 months. The mean actuarial survival at 2 and 5 years was 61% and 17%. At the end of the study, five patients were alive: two were disease free, one had recurrent disease, one had margin involvement and one was awaiting resection of the primary tumor. Eight patients died. One patient survived 9 years after surgery.

LA for metastasis can be performed without oncological disadvantage and should be offered to patients with resectable disease, a DFI > 6 months, and a tumoral size that allows laparoscopic resection.