Patient selection for laparoscopic excision of adrenal metastases: a multicenter cohort studyReportar como inadecuado

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* Corresponding author 1 Service d-Urologie - Transplantation Rénale - Andrologie 2 Service d-urologie 3 Service d-anatomie et cytologie pathologiques Rennes 4 IGDR - Institut de Génétique et Développement de Rennes 5 TOULOUSE - Endocrino - Service d-Endocrinologie 6 LTSI - Laboratoire Traitement du Signal et de l-Image 7 EA 3694

Abstract : Introduction The use of laparoscopy for the excision of adrenal metastasis remains controversial. We aimed to report oncological and perioperative outcomes of laparoscopic excision of adrenal metastases and to seek for predictive factors of unfavourable oncological outcomes. Methods A retrospective chart review was conducted and all consecutive patients who underwent laparoscopic adrenalectomy LA in the setting of metastatic cancer in two academic urology departments from November 2006 through January 2014 were included. Primary tumors were categorized as pulmonary, renal or -other primary- tumors to allow statistical comparison. Unfavourable surgical outcomes were defined as the occurrence of either postoperative complications and-or positive surgical margins. Results Forty-three patients who underwent a total of 45 LA were included for analysis. There were 8 complications 17.8%. Positive surgical margins were found in 12 specimens 26.7%. After a median follow-up of 37 months, estimated overall survival rates were 89.5% and 51.5% at 1 year and 5 years, respectively. In multivariable analysis the only predictor of unfavourable surgical outcomes was a tumor size > 5 cm OR= 20.5; p=0.001. In multivariate analysis the pulmonary OR=0.3; p=0.008 or -other- OR= 0.1; p=0.0006 origin of the primary tumor was the only prognostic factor of shorter cancer specific survival. Conclusion Laparoscopic resection of adrenal metastasis can be safely performed in most patients but is associated with an increased risk of positive surgical margins and postoperative complications in larger tumors >5 cm. Adrenalectomy provides better oncological outcomes in metastases from renal cell carcinoma compared to other primary tumors.

Keywords : adrenal adrenalectomy Laparoscopy metastasis

Autor: Alexandre Gryn - Benoit Peyronnet - Andréa Manunta - Jean-Baptiste Beauval - Elie Bounasr - François-Xavier Nouhaud - Nathalie



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