Laparoscopic adrenalectomy for suspected metastasis of adrenal glands: our experience.

OBJECTIVES

To present our experience in laparoscopic adrenalectomy for isolated adrenal metastasis.

METHODS

A total of 34 adrenalectomies were performed in 32 patients for incidental adrenal masses discovered at primary tumor diagnosis or during follow-up. The primary tumors diagnosed were 13 cases of lung carcinoma, 9 of renal cell carcinoma, 2 of colorectal carcinoma, 2 of bladder carcinoma, and 1 each of ovarian carcinoma, breast cancer, gastric cancer, and melanoma. Two patients had no history of a primary tumor. The mean patient age was 59 years (range 26 to 75). The male/female ratio was 1.9:1.

RESULTS

The mean operative time was 87 minutes (range 40 to 240). The average blood loss was 89 mL (range 0 to 1000). No conversions to open surgery were needed. The mean hospital stay was 3 days (range 1 to 5). One intraoperative diaphragmatic lesion developed that was repaired laparoscopically, and 1 patient had a pancreatic fistula that was managed by percutaneous drainage. The mean tumor size was 4.3 cm (range 1.5 to 9). The microscopic analysis revealed 22 malign lesions (64.7%) and 12 cases of benign pathologic features (35.3%). The mean survival time was 26 months (range 4 to 64) for the 22 patients with malign lesions. In 2 patients (9.1%), the surgical margins were positive.

CONCLUSIONS

Laparoscopic adrenalectomy for small isolated metastases is feasible. However, because of the high risk of positive margins, this procedure should only be done by expert laparoscopists. We did not find a correlation between mass size and malignancy. Nevertheless, we believe that longer follow-up is mandatory before definitive conclusions can be drawn.