Clinical Outcomes of Adrenalectomy for Metastatic Adrenal Tumor: A 30-case Single-center Study

The adrenal gland is a common site of metastasis from various primary malignancies, and adrenalectomy may provide long-term survival benefits in carefully selected patients. However, prognostic factors influencing overall survival (OS) after adrenalectomy for metastatic adrenal tumors remain insufficiently defined. In addition, the optimal surgical approach - particularly the appropriateness of laparoscopic versus open adrenalectomy - continues to be a subject of ongoing debate.

We retrospectively analyzed 30 patients who underwent adrenalectomy for metastatic adrenal tumors at a single institution between November 2006 and March 2025. Clinicopathological features, perioperative outcomes, and OS were evaluated. To examine differences in surgical invasiveness and prognosis, patients were stratified by tumor size (<5 cm vs. ≥5 cm).

The median tumor size was 2.6 cm, and 93% of patients underwent laparoscopic adrenalectomy. Extended adrenalectomy was required in 20%, and the open conversion rate was 7%. Patients with tumors ≥5 cm exhibited longer operative time, greater blood loss, higher rates of extended adrenalectomy and open conversion, and more frequent perioperative complications. The median OS for the entire cohort was 130 months. Patients with tumors ≥5 cm had significantly worse OS (log-rank p=0.02). In multivariate analysis, tumor size ≥5 cm was identified as an independent predictor of poor OS [hazard ratio (HR)=4.985, p=0.045].

Adrenalectomy can achieve favorable long-term survival in selected patients with adrenal metastasis. Laparoscopic adrenalectomy is an effective minimally invasive option for tumors <5 cm, whereas tumors ≥5 cm are associated with greater surgical invasiveness and poorer prognosis, necessitating careful operative planning and consideration of open adrenalectomy.