The non-responding adrenal metastasis in melanoma: The case for minimally invasive adrenalectomy in the age of modern therapies

Minimally invasive adrenalectomy has facilitated resection of resistant adrenal metastases. The adrenal gland may function as a sanctuary site for metastatic growth despite systemic therapy. The objective of the study was to assess the outcomes of selective minimally invasive adrenalectomy during im...

Full description

Saved in:
Bibliographic Details
Published in:The American journal of surgery 2020-08, Vol.220 (2), p.349-353
Main Authors: Zippel, Douglas, Yalon, Tal, Nevo, Yehonatan, Markel, Gal, Asher, Nethanel, Schachter, Jacob, Goitein, David, Segal, Tamar Abramovich, Nissan, Aviram, Hazzan, David
Format: Article
Language:English
Subjects:
Adrenal gland
Adrenal glands
Adrenalectomy
Advantages
Age
Immunotherapy
Laparoscopy
Medical prognosis
Melanoma
Metastases
Metastasis
Metastatic melanoma
Minimally invasive surgery
Morbidity
Patients
Robotics
Signal transduction
Surgery
Therapy
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Minimally invasive adrenalectomy has facilitated resection of resistant adrenal metastases. The adrenal gland may function as a sanctuary site for metastatic growth despite systemic therapy. The objective of the study was to assess the outcomes of selective minimally invasive adrenalectomy during immunotherapy. Candidates included patients with adrenal metastases resistant to systemic therapy who underwent minimally invasive adrenalectomy. There were 15 patients undergoing 16 minimally invasive adrenalectomies. Patients received either immunotherapy or BRAF inhibition prior to surgery. The mean operative time was 130 min with a median length of hospital stay of 2 days. At a median follow up of 24 months, 7 patients have no evidence of disease, 6 patients had progression with eventual mortality, while another patients has stable disease with maintenance therapy. One was lost to follow up. Despite an increase in objective durable responses in metastatic melanoma, there is still some site-specific resistance in isolated areas like the adrenal where early minimally invasive adrenalectomy remains indicated. •Minimally invasive adrenalectomy is indicated for resistant to therapy melanoma.•There can be site-specific resistance in isolated areas like the adrenal.•The adrenal gland may function as a sanctuary site for metastatic growth. Despite an increase in objective durable response in metastatic melanoma to immunotherapies and targeted treatments, minimally invasive adrenalectomy offers advantage in adrenal disease resistant to medical therapy.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2019.11.033