Faculty Collaboration Database

Adrenalectomy for Secondary Malignancy: Patients, Outcomes, and Indications. Ann Surg 2021 Dec 01;274(6):1073-1080

Date

05/20/2020

Pubmed ID

32427760

DOI

10.1097/SLA.0000000000003876

Scopus ID

2-s2.0-85121964615 (requires institutional sign-in at Scopus site)   14 Citations

Abstract

OBJECTIVE: The goal of this study was to examine a multi-institutional experience with adrenal metastases to describe survival outcomes and identify subpopulations who benefit from adrenal metastasectomy.

BACKGROUND: Adrenalectomy for metastatic disease is well-described, although indications and outcomes are incompletely defined.

METHODS: A retrospective cohort study was performed of patients undergoing adrenalectomy for secondary malignancy (2002-2015) at 6 institutions. The primary outcomes were disease free survival (DFS) and overall survival (OS). Analysis methods included Kaplan-Meier and Cox proportional hazards.

RESULTS: Of 269 patients, mean age was 60.1 years; 50% were male. The most common primary malignancies were lung (n = 125, 47%), renal cell (n = 38, 14%), melanoma (n = 33, 12%), sarcoma (n = 18, 7%), and colorectal (n = 12, 5%). The median time to detection of adrenal metastasis after initial diagnosis of the primary tumor was 17 months (interquartile range: 6-41). Post-adrenalectomy, the median DFS was 18 months (1-year DFS: 54%, 5-year DFS: 31%). On multivariable analysis, lung primary was associated with longer DFS [hazard ratio (HR): 0.49, P = 0.008). Extra-adrenal oligometastatic disease at initial presentation (HR: 1.84, P = 0.016), larger tumor size (HR: 1.07, P = 0.013), chemotherapy as treatment of the primary tumor (HR: 2.07 P = 0.027) and adjuvant chemotherapy (HR: 1.95, P = 0.009) were associated with shorter DFS. Median OS was 53 months (1-year OS: 83%, 5-year OS: 43%). On multivariable analysis, extra-adrenal oligometastatic disease at adrenalectomy (HR: 1.74, P = 0.031), and incomplete resection of adrenal metastasis (R1 margins; HR: 1.62, P = 0.034; R2 margins; HR: 5.45, P = 0.002) were associated with shorter OS.

CONCLUSIONS: Durable survival is observed in patients undergoing adrenal metastasectomy and should be considered for subjects with isolated adrenal metastases.

Author List

Wachtel H, Roses RE, Kuo LE, Lindeman BM, Nehs MA, Tavakkoli A, Parangi S, Hodin RA, Fraker DL, James BC, Carr AA, Wang TS, Solórzano CC, Lubitz CC

Author

Tracy S. Wang MD, MPH Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adrenal Gland Neoplasms
Adrenalectomy
Chemotherapy, Adjuvant
Female
Humans
Male
Metastasectomy
Middle Aged
Radiotherapy, Adjuvant
Retrospective Studies
Survival Rate
United States