The authors do not have commercial interests in the subjects of the study and the source of any financial or material support.
A multi-center study on the surgical management of metastatic disease to adrenal glands†
Article first published online: 29 DEC 2010
Copyright © 2010 Wiley-Liss, Inc.
Journal of Surgical Oncology
Volume 103, Issue 5, pages 400–405, April 2011
How to Cite
Valeri, A., Bergamini, C., Tozzi, F., Martellucci, J., Di Costanzo, F. and Antonuzzo, L. (2011), A multi-center study on the surgical management of metastatic disease to adrenal glands. J. Surg. Oncol., 103: 400–405. doi: 10.1002/jso.21843
- Issue published online: 11 MAR 2011
- Article first published online: 29 DEC 2010
- Manuscript Accepted: 29 NOV 2010
- Manuscript Received: 6 SEP 2010
- adrenal metastasis;
- laparoscopic adrenalectomy;
- survival curves;
- adrenal FNA
In the management of adrenal lesions in oncological patients, many issues are still controversial: morphological signs of suspected malignancy, accuracy of imaging examinations, use of fine needle aspiration (FNA), and the role of laparoscopy. The present study attempts to address these questions through the evaluation of the management of adrenal metastases (AM) in a wide cohort of patients included in the Italian Register of Endoscopic Adrenal Surgery.
In January 2009, all patients recorded on the Register were evaluated, on the basis of CT scan, MRI, and FNA. The diagnostic, surgical, and follow-up data of 95 patients with pre-operative AM diagnosis have been reviewed. On the basis of the fulfilled criteria three patterns were identified: “diagnostic”, “suspect,” and “non-diagnostic.”
CT scan sensitivity was 41.5%/77.9% and specificity was 54.5%/90.9% for “diagnostic”/“diagnostic” + “suspect” examinations, respectively. MRI sensitivity was 15.7%/78.9% and specificity was non-determinate/83.3% for “diagnostic”/“diagnostic” + “suspect” exams, respectively. Sensitivity of FNA was 33.3%. About surgery, conversions rate was 16.6%; no mortality or re-operations were reported; complications rate was 10.7%; and no relation was noted between tumor size and surgical outcome. Mean survival was 32 months; 5-year survival was 23%, independent of AM size; survival for lung AM was similar to that of breast and kidney AM.
Laparoscopy for AM, in expert hand, seems to be a feasible and oncologically safe approach. Due to the unsatisfactory diagnostic accuracy for AM, every oncological patient with suspect adrenal lesions should be encouraged to undergo this surgical procedure. J. Surg. Oncol. 2011; 103:400–405. © 2010 Wiley-Liss, Inc.