• Heather Wachtel, Robert E Roses, Lindsay E Kuo, Brenessa M Lindeman, Matthew A Nehs, Ali Tavakkoli, Sareh Parangi, Richard A Hodin, Douglas L Fraker, Benjamin C James, Azadeh A Carr, Tracy S Wang, Carmen C Solórzano, and Carrie C Lubitz.
• Hospital of the University of Pennsylvania, Department of Surgery, and Perelman School of Medicine, University of Pennsylvania, Philadelphia PA.
• Ann. Surg. 2021 Dec 1; 274 (6): 1073-1080.

ObjectiveThe goal of this study was to examine a multi-institutional experience with adrenal metastases to describe survival outcomes and identify subpopulations who benefit from adrenal metastasectomy.BackgroundAdrenalectomy for metastatic disease is well-described, although indications and outcomes are incompletely defined.MethodsA retrospective cohort study was performed of patients undergoing adrenalectomy for secondary malignancy (2002-2015) at 6 institutions. The primary outcomes were disease free survival (DFS) and overall survival (OS). Analysis methods included Kaplan-Meier and Cox proportional hazards.ResultsOf 269 patients, mean age was 60.1 years; 50% were male. The most common primary malignancies were lung (n = 125, 47%), renal cell (n = 38, 14%), melanoma (n = 33, 12%), sarcoma (n = 18, 7%), and colorectal (n = 12, 5%). The median time to detection of adrenal metastasis after initial diagnosis of the primary tumor was 17 months (interquartile range: 6-41). Post-adrenalectomy, the median DFS was 18 months (1-year DFS: 54%, 5-year DFS: 31%). On multivariable analysis, lung primary was associated with longer DFS [hazard ratio (HR): 0.49, P = 0.008). Extra-adrenal oligometastatic disease at initial presentation (HR: 1.84, P = 0.016), larger tumor size (HR: 1.07, P = 0.013), chemotherapy as treatment of the primary tumor (HR: 2.07 P = 0.027) and adjuvant chemotherapy (HR: 1.95, P = 0.009) were associated with shorter DFS. Median OS was 53 months (1-year OS: 83%, 5-year OS: 43%). On multivariable analysis, extra-adrenal oligometastatic disease at adrenalectomy (HR: 1.74, P = 0.031), and incomplete resection of adrenal metastasis (R1 margins; HR: 1.62, P = 0.034; R2 margins; HR: 5.45, P = 0.002) were associated with shorter OS.ConclusionsDurable survival is observed in patients undergoing adrenal metastasectomy and should be considered for subjects with isolated adrenal metastases.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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