Patient selection for laparoscopic excision of adrenal metastases: A multicenter cohort study.

INTRODUCTION: The use of laparoscopy for the excision of adrenal metastasis remains controversial. We aimed to report oncological and perioperative outcomes of laparoscopic excision of adrenal metastases and to seek for predictive factors of unfavorable oncological outcomes.

METHODS: A retrospective chart review was conducted and all consecutive patients who underwent laparoscopic adrenalectomy (LA) in the setting of metastatic cancer in two academic urology departments from November 2006 through January 2014 were included. Primary tumors were categorized as pulmonary, renal or "other primary" tumors to allow statistical comparison. Unfavorable surgical outcomes were defined as the occurrence of either postoperative complications and/or positive surgical margins.

RESULTS: Forty-three patients who underwent a total of 45 LA were included for analysis. There were 8 complications (17.8%). Positive surgical margins were found in 12 specimens (26.7%). After a median follow-up of 37 months, estimated overall survival rates were 89.5% and 51.5% at 1 year and 5 years, respectively. In multivariable analysis the only predictor of unfavorable surgical outcomes was a tumor size >5 cm (OR = 20.5; p = 0.001). In multivariate analysis the pulmonary (OR = 0.3; p = 0.008) or "other" (OR = 0.1; p = 0.0006) origin of the primary tumor was the only prognostic factor of shorter cancer specific survival.

CONCLUSION: Laparoscopic resection of adrenal metastasis can be safely performed in most patients but is associated with an increased risk of positive surgical margins and postoperative complications in larger tumors (>5 cm). Adrenalectomy provides better oncological outcomes in metastases from renal cell carcinoma compared to other primary tumors.