Outcome and prognosis after adrenal metastasectomy: nationwide study

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  • Elizabeth Vlk, Aarhus Universitet
  • ,
  • Andreas Ebbehoj
  • Frede Donskov, Hospital Lillebaelt, Middelfart, Denmark, University of Southern Denmark, Odense, Denmark, and Aarhus University Hospital, Aarhus, Denmark.
  • ,
  • Per Løgstrup Poulsen
  • Badal Sheiko Rashu, From the Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital (A.D.K., S.E.B., B.G.N.), Faculty of Health and Medical Sciences (A.D.K., J.S.J., S.E.B., B.G.N.), The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital (A.D.K., S.E.B., B.G.N.), Department of Medicine and Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital (J.S.J.), and The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhage
  • ,
  • Lasse Bro, From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark.
  • ,
  • Mikael Aagaard, Københavns Universitet
  • ,
  • Lars Rolighed

BACKGROUND: Data regarding adrenal metastasectomy are limited. Here, clinical outcomes, safety, and prognostic factors in patients undergoing adrenal metastasectomy were evaluated in a large nationwide study.

METHODS: Patients undergoing adrenal metastasectomy between 2000 and 2018 were identified in the Danish National Pathology Registry. Medical records were reviewed to confirm eligibility and to collect clinical data. The primary outcome was overall survival (OS). Cox multivariable regression analyses were? adjusted for baseline factors.

RESULTS: In total, 435 patients underwent adrenal metastasectomy; the primary cancer origins were renal (n = 195, 45 per cent), lung (n = 121, 28 per cent), colorectal (n = 50, 11 per cent), and other (n = 69, 16 per cent). The median (interquartile range; i.q.r.) age was 66 (59-71) years, and 280 (64 per cent) were men. The 5-year OS was 31 per cent. The 30-day mortality was 1.8 per cent. Complications were more frequent and severe in patients who underwent open surgery compared with laparoscopic surgery (Clavien-Dindo III-V, 31.5 per cent versus 11.8 per cent respectively, P < 0.001). Factors associated with poor survival included non-radical pR2 resection (hazard ratio (HR) 3.57, 95 per cent c.i. 1.96 to 6.48), tumour size more than 50 mm (HR 1.79, 95 per cent c.i. 1.26 to 2.52), lung cancer origin (HR 1.77, 95 per cent c.i. 1.31 to 2.40), open surgical approach (HR 1.33, 95 per cent c.i. 1.04 to 1.71), presence of extra-adrenal metastases (HR 1.31, 95 per cent c.i. 1.01 to 1.71), and increasing Charlson co-morbidity index factors (HR 1.14 per one-point increase, 95 per cent c.i. 1.03 to 1.27).

CONCLUSION: Adrenal metastasectomy is safe and may result in long-term survival in a subset of patients. Non-radical resection, large tumour size, lung cancer origin, open approach, presence of extra-adrenal metastases, and co-morbidity were associated with inferior outcomes.

TidsskriftBJS Open
StatusUdgivet - 8 mar. 2022

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© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.

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