B Furthermore, the differential diagnosis of an isolated adrenal mass in the setting of another malignancy can be troubling with the role of biopsy controversial and potentially associated with complications such as tract seeding or tumor rupture. Surgical resection of these lesions has traditionally been through open approaches, due to the fear of possible tumor rupture during laparoscopic manipulation. Here, Castillo and colleagues report on their experience with laparoscopic resection of isolated adrenal metastases.

The authors report on 34 adrenalectomies in 32 patients. Primary tumors in these patients included 13 with lung cancer, 9 with renal cell carcinoma, 2 with colorectal cancer, 2 with bladder cancer, and one each of ovarian, breast, gastric, and melanoma. Regarding peri-operative parameters the authors report a mean OR time of 87 minutes, mean blood loss of 89 ml, mean length of stay of 3 days, and only 3 complications with no open conversions. Of the resected adrenal lesions, 64.7% were metastatic cancer and 35.3% were benign tumors. There was no significant difference in size between benign and malignant tumors. The positive margin rate was 9.1%. Two cases had renal vein invasion and required a bloc nephrectomy. Of those patients with malignancy on final pathology their overall survival was 26 months (range 4-64 months).

The authors conclude that laparoscopic resection of adrenal masses in the setting of another primary malignancy for presumed isolated metastasis is feasible, safe, and efficacious. They caution that it should only be performed by experienced laparoscopic surgeons because of the real risk of positive margins and tumor rupture.

Castillo OA, Vitagliano G, Kerkebe M, Parma P, Pinto I, Diaz M

Urology. 69(4):637-641, April 2007.
doi:10.1016/j.urology.2006.12.025

UroToday.com Laproscopic and Robotic Section

Written by Christopher G. Wood, MD, a Contributing Editor with UroToday.

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