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Retroperitoneoscopic partial adrenalectomy for metachronous renal cell carcinoma metastasis to solitary adrenal gland.

ABSTRACT: Metastasectomy is a widely accepted treatment for renal cell carcinoma (RCC) metastasis, and is regarded as the most effective strategy for increasing the rate of cancer-specific survival. However, since bilateral synchronous or metachronous adrenal metastasis of RCC is extremely rare, a standard approach has yet to be established. Partial adrenalectomy may avoid lifelong hormonal supplementation and reduce the risk of Addisonian crisis. A 71-year-old man had a previous history of left nephrectomy and ipsilateral adrenalectomy for metachronous adrenal metastasis. Metachronous contralateral adrenal metastasis was detected 2 years after ipsilateral adrenalectomy, and he underwent retroperitoneoscopic partial adrenalectomy using a vessel sealing device. Although corticosteroid replacement therapy was not prophylactically performed, the patient did not exhibit any symptoms of hypocorticism. Nine months after the surgery, the patient remains well without steroid supplementation, and neither local recurrence nor metastasis has been detected. To the best of our knowledge, this is the first case report of laparoscopic partial adrenalectomy for RCC metastasis. The vessel sealing device was highly effective and suitable for laparoscopic partial adrenalectomy.

SUBMITTER: Kaneko G

PROVIDER: S-EPMC6942610 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Retroperitoneoscopic partial adrenalectomy for metachronous renal cell carcinoma metastasis to solitary adrenal gland.

Kaneko Go G Katsui Masahiro M Orikasa Hideki H Hattori Seiya S Hara Satoshi S

International cancer conference journal 20190723 1

Metastasectomy is a widely accepted treatment for renal cell carcinoma (RCC) metastasis, and is regarded as the most effective strategy for increasing the rate of cancer-specific survival. However, since bilateral synchronous or metachronous adrenal metastasis of RCC is extremely rare, a standard approach has yet to be established. Partial adrenalectomy may avoid lifelong hormonal supplementation and reduce the risk of Addisonian crisis. A 71-year-old man had a previous history of left nephrecto ...[more]

PMID: 31950008

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Project description:PurposeThe indications for adrenalectomy and feasibility of laparoscopic adrenalectomy for adrenal metastasis are controversial. This study aimed to compare the surgical outcomes between open adrenalectomy (OA) and laparoscopic adrenalectomy (LA) and to evaluate the prognostic factors for oncological outcomes of adrenal metastasis.Materials and methodsWe conducted a retrospective chart review of 141 consecutive patients who underwent adrenalectomy for adrenal metastasis at Seoul National University Hospital from April 2005 to February 2021. Surgical and oncological outcomes were compared between OA and LA.ResultsOA was performed in 95 (67.4%) patients, and 46 (32.6%) patients underwent LA. Among the patients who underwent adrenalectomy without adjacent organ resection for adrenal tumors less than 8 cm, LA was associated with a shorter operation time (100.1 ± 48.8 vs. 158.6 ± 81.2, P = 0.001), less blood loss (94.8 ± 93.8 vs. 566.8 ± 1156.0, P = 0.034), and a shorter hospital stay (3.7 ± 1.3 vs. 6.9 ± 5.8, P = 0.003). For locoregional recurrence-free survival (LRRFS), on multivariate analysis, a positive pathological margin (hazard ratio [HR]: 5.777, P = 0.002), disease activity at the primary site (HR: 6.497, P = 0.005), other metastases (HR: 4.154, P = 0.015), and a relatively larger tumor size (HR: 1.198, P = 0.018) were significantly associated with poor LRRFS. Multivariate analysis indicated that metachronous metastasis (HR: 0.51, P = 0.032) was associated with a longer overall survival (OS), whereas a positive pathological margin (HR: 2.40, P = 0.017), metastases to other organs (HR: 2.08, P = 0.025), and a relatively larger tumor size (HR: 1.11, P = 0.046) were associated with a shorter OS.ConclusionsLA is a feasible treatment option for adrenal metastasis in selected patients. The pathological margin, metastases to other organs, and tumor size should be considered in adrenalectomy for adrenal metastasis.

Dataset Information

Retroperitoneoscopic partial adrenalectomy for metachronous renal cell carcinoma metastasis to solitary adrenal gland.

Publications

Retroperitoneoscopic partial adrenalectomy for metachronous renal cell carcinoma metastasis to solitary adrenal gland.

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