Adrenal Metastasectomy in the

Presence and Absence of

Extraadrenal Metastatic Disease
Annals of Surgery270(2):373-377, August 2019.

Maria Espinoza, MPH

Medical Student
Keck School of Medicine
 Background

• Oligometastasis: Metastatic tumors limited to

2-3 organs
– Implication: Unique patient population in which
local therapeutic modalities (surgical resection,
radiofrequency ablation, etc.) could be curative
 Introduction

Study Question: Are there differences in overall

survival or event-free survival in pt with and
without concomitant extraadrenal metastases
undergoing adrenal metastasectomy?

Relevance: Current series have conflicting

findings, some show decreased survival among
pt with extraadrenal mets, others show no
difference
 Methods
• Study Design: Retrospective Observational
• Prospective Database from 1994-2015 for pt undergoing
adrenalectomy
• Site: Sloan-Kettering Cancer Center
• Exclusion criteria:
– History of palliative resection
– Adrenalectomy indicated for direct extension of tumor from
another site
• Primary Outcomes-
– Overall Survival: From date of adrenalectomy to last known
follow-up or death
– Event-Free Interval: Recurrence (NED pt), Progression (AWD
pt), death
 Methods
• Overall Survival and Event-Free Survival
estimated using Kaplan-Meier method
• Cox proportional-hazards model used to
examine association between extra-adrenal
met status and disease characteristics and
outcomes
• P vale < 0.05 considered statistically significant
 Demographic and Clinical Data Results
Extra-Adrenal Isolated Adrenal Met Total
Met (n=91) (N=174)
(n=83)
Age 60 (51-67) 65 (54-71) 62 (53-70)
Sex
Male 45 (54%) 56 (62%) 101 (58%)
Female 38 (46%) 35 (28%) 73 (42%)
Operation
Lap 34 (41%) 37 (41%) 71 (41%)
Open 49 (59%) 54 (59%) 103 (59%)
Primary Site
NSCLC 20 (24%) 48 (53%) 68 (39%)
Renal 11 (13%) 23 (25%) 34 (20%)
Colorectal 18 (22%) 0 (0%) 18 (10%)

Margins
Negative 20 (24%) 16 (18%) 36 (21%)
Positive 62 (75%) 75 (82%) 137 (79%)
Median tumor size 4.0cm 4.6cm 4.50cm
Overall Survival of pt Undergoing Adrenal Metastasectomy

Extra-Adrenal Isolated Adrenal P value

Mets Mets

3.3yr 3.0yr 0.816

Event-Free Survival of pt Undergoing Adrenal Metastasectomy

Extra-Adrenal Isolated Adrenal P value

Mets Mets

9 months 10 months 0.87

 Factors associated with Overall Survival
HR (95% CI) P
Extra-adrenal mets .816
Yes 0.95 (.66-1.38)
No Reference
Age,yr .782
>62 1.05 (0.73-1.51)
<62 Reference
Sex 0.96
Male 1.008 (0.69-1.46)
Female Reference
Tumor size, cm
>4.5 1.78 (1.22-2.58) <0.01
<4.5 Reference
Primary site
NSLC 1.00 (0.67-1.49) 0.973
Renal 0.42 (0.23-0.75) <0.01
Other Reference
Operation approach 0.19
Lap 1.28 (0.87-1.88)
Open 49 (59%)
Margin <0.01
Positive 2.1 (1.36-3.14)
Negative Reference
 Strengths & Limitations
• Strength: Largest series to date to address this
clinical question

• Limitations:
– Clinical heterogeneity primary tumor and previous
medical management makes outcomes data
application data difficult
– Lack of control group (i.e. tx with chemotherapy)
 Conclusion

• Similar long-term outcomes between pt with

isolated adrenal mets and those with extra-
adrenal mets who undergo adrenalectomy
• Pt with presence or history of extraadrenal
metastatic disease should not be a
contraindication for adrenalectomy