Laparoscopic Adrenal Metastatectomy: Appropriate, safe, and feasible

Judy Chen, MD, Ali Tavakkoli, MD

Brigham and Women’s Hospital

Background: The role of adrenal resection in management of metastatic adrenal tumors is not well established. Furthermore, whether such resections should be done laparoscopically or through open surgery is unknown. We aimed to evaluate outcomes of patients who underwent adrenal metastectomy, comparing outcomes between laparoscopic vs. open approach.

Methods: We retrospectively reviewed our institutional experience with adult patients who underwent an adrenal metastatectomy between 1997 and 2012. Pre-operative tumor size, status of resection margin, OR time, length of stay and use of chemotherapy in the immediate post-operative period were assessed. Median values are reported and p values calculated using Mann–Whitney U test.

Results: Total of 38 patients were identified with lung being the primary site of malignancy in 50% cases; 47.4% (n = 18) were resected laparoscopically and 52.6% (n = 20) patients were done open. In the laparoscopic group, median tumor size was 2.7cm (range 1-10cm) vs. 4.6cm in the open group (range 2.1 -9.8 cm)(p = 0.03)(Table 1). A negative resection margin was achieved in all laparoscopic cases and 85% of the open cases. Median OR time in the laparoscopic group was 140 min vs. 175 for the open group (p = 0.41). Median length of stay was significantly shorter in the laparoscopic group (4 vs. 5.5 days for the open group; p = 0.02) (Table 1). Over 40% of patients did not require post-operative chemotherapy, with 75% of the cohort alive with a follow up range of 3-90 months.

Conclusions: This series, one of the largest in the literature, confirms that adrenal metastatectomy can lead to good oncological outcomes in selected patients with over 40% of not requiring continuation chemotherapy in the immediate post-operative period. Laparoscopic approach leads to excellent oncological resection margins without increasing OR time, but with a reduction in length of stay (LOS).

Table 1

Laparoscopic approach
Open approach
Median patients age 63 60 0.186
Max tumor size (cm) 2.7 4.6 0.030
Negative Resection Margin 100% 85% NS
OR Time (mins) 140 175 0.408
LOS (days) 4 5.5 0.017
No Post-operative Chemotherapy 40% 44.5% NS

Session: Podium Presentation

Program Number: S029

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