Posterior retroperitoneal adrenalectomy for metastatic disease: a multi-site Australian series

• Published in: ANZ journal of surgery 2024-11
• Main Authors: Fenton, Mark, Leong, David, Wong, Jessica, Zotov, Paul, Farrell, Stephen, Miller, Julie A, Sywak, Mark S, O'Neill, Christine J
• Format: Article
• Language: English
• ISSN: 1445-1433; 1445-2197; 1445-2197
• DOI: 10.1111/ans.19308

Posterior retroperitoneoscopic adrenalectomy (PRA) for isolated adrenal metastasis is minimally invasive, may prolong survival and improve quality of life. The current evidence base is scant. A multi-site retrospective analysis of all cases of PRA for adrenal metastasis between 2011 and 2023, by four high-volume adrenal surgeons was performed. Perioperative morbidity, disease-free and survival outcomes were reported. Of 51 patients, 34(67%) male, mean age 63 ± 12 years, mean BMI 28; 49 PRAs for adrenal metastatectomy were completed (one abandoned due to tumour unresectability, one conversion to anterior laparoscopic approach) across 11 hospitals (49% public). Primary tumours included: 11 colorectal, 11 renal, 8 lung, 6 hepatocellular, 4 sarcoma, 3 breast, 2 melanoma, 2 ovarian and 1 each of pancreatic, oesophageal, testicular and prostate cancer. There were 12 synchronous (6 months after primary diagnosis) tumours; 21 (42%) left sided, none bilateral. Mean operative time was 95 ± 34 minutes, mean maximal tumour diameter was 34 mm ± 13 mm and median length of hospitalization 1 ± 1 days. There were 8 (16%) complications; 1 ICU admission, 1 re-admission for pneumonia and 6 Clavien-Dindo grade I complications. There were 10 (20%) mortalities and a median overall survival of 29 months (range 7-123, n = 41). Disease recurred in 15 (40%) patients (n = 37), with a median disease-free interval of 18 months (range 1-68). Port site recurrence occurred in 2 patients, both simultaneously with disseminated metastases. In carefully selected patients with adrenal metastases, PRA by high-volume adrenal surgeons has minimal morbidity and short hospitalization. Surgery should be considered prior to local ablation.