The role of surgery in the treatment of clinically isolated adrenal metastasis.

Overview

BACKGROUND: Clinically isolated adrenal metastasis is rare. The role of surgical resection is unknown. The aim of this study was to define clinical and pathologic parameters that might predict long term survival after resection of adrenal metastasis. METHODS: The authors conducted a retrospective review of 37 patients who had undergone adrenalectomy for metastatic disease at the Memorial Sloan-Kettering Cancer Center (MSKCC) between July 1986 and October 1996. Patients who underwent resection of tumors that locally invaded the adrenal gland were excluded from the study, as were all patients with primary adrenal tumors. RESULTS: There were 24 men and 13 women, with a median age of 58 years (range, 42-77 years). Lung carcinoma was the most common primary tumor (n = 17), followed by renal cell carcinoma (n = 9), and colorectal carcinoma (n = 5). The median length of stay at MSKCC was 8 days (range, 3-21 days). There was a 19% incidence of complications (12% major). There was one perioperative death. Five-year survival for the entire group was 24% (median, 21 months). Disease free interval (DFI) of > 6 months and complete resection were the only predictors of improved survival. CONCLUSIONS: Adrenalectomy for clinically solitary, resectable lesions can be performed safely, and prolonged survival can be achieved in such selected patients. Adrenalectomy should be considered for patients with completely resectable disease and a DFI of > 6 months.