Safety and outcomes of laparoscopic adrenalectomy for metastatic tumors - experience in a high-volume urological center

Emilia Niedziela; Łukasz Niedziela; Jarosław Jaskulski; Mateusz Obarzanowski; Aldona Kowalska

doi:10.1530/endoabs.99.EP313

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Endocrine Abstracts (2024) 99 EP313 | DOI: 10.1530/endoabs.99.EP313

ECE2024 Eposter Presentations Endocrine-Related Cancer (90 abstracts)

Safety and outcomes of laparoscopic adrenalectomy for metastatic tumors – experience in a high-volume urological center

Emilia Niedziela ^1,2 , Łukasz Niedziela ^2,3 , Jarosław Jaskulski ^2,3 , Mateusz Obarzanowski ^2,3 & Aldona Kowalska ^1,2

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¹Holy Cross Cancer Center, Department of Endocrinology, Kielce, Poland; ²Collegium Medicum, Jan Kochanowski University, Kielce, Poland; ³Holy Cross Cancer Center, Department of Urology, Kielce, Poland

Introduction: In case of isolated adrenal metastases, complete surgical resection of the disease is a potentially curative treatment. Minimally invasive adrenalectomy is recommended in most patients with focal adrenal lesions without evidence of local invasion. However, data on surgical outcomes and survival after laparoscopic adrenalectomy (LA) for adrenal metastases are still lacking to clearly define the role of this procedure in the management of metastatic disease.

Aim: The aim of the study is to assess the safety and outcomes of LA for metastatic adrenal tumors.

Methods: We retrospectively analyzed the data of patients undergoing LA between 2015 and 2021 in tertiary medical center. Perioperative and postoperative complications, as well as long-term outcomes were recorded.

Results: A total of 141 patients were enrolled in the study. 22 LAs were performed for adrenal metastases of different origin, including 18 for renal cell carcinoma (RCC; 81.8%), 3 for lung cancer (LC; 13.6%) and 1 for colorectal cancer (CC; 4.5%). One patient underwent a single-stage bilateral adrenalectomy, while the others had unilateral surgery. 4 patients had second LA due to metachronous adrenal metastases. Intraoperative complications occurred during 2 LAs (9.1%) including injury of the inferior vena cava and pancreatic tail. Open conversion was performed during 2 LAs (9.1%). 30-day postoperative complications were reported in 4 cases (18.2%). No life-threatening complications were observed in the postoperative period. 90,9% resection margins were tumor-free (R0). At the follow-up, systemic treatment was administrated to all patients with metastatic LC and CC, and to 27.8 % of patients with RCC. After a median follow-up of 4 years (range 0.2–8.8), 10 patients (45%) died of cancer or other causes. The 1-, and 5-year overall survival (OS) rate after LA were 85% and 40%, respectively. Tumor size on imaging tended to be associated with shorter OS.

Conclusions: LA for adrenal metastases is a safe method with good surgical and oncologic outcomes. It requires a proper qualification of patients for the procedure by a multidisciplinary team and surgeon’s experience.