Introduction

Until the early 2000s, ipsilateral adrenalectomy at the time of radical nephrectomy was genrally recommended except in small tumors of the lower pole. In the current era, as radical nephrectomy sparing the adrenal gland has become the gold standard, the incidence of metachronous adrenal metastases has increased. However, to date no study has aimed to assess the outcomes of adrenalectomy for metastasis of renal cell carcinoma (RCC). The aim of this study was to report the outcomes of adrenalectomy for metastasis of RCC.

Methods

All adrenalectomies for suspected adrenal metastases of RCC performed in seven centers between 2006 and 2016 were included in a retrospective study. The adrenalectomies performed at the time of ipsilateral nephrectomy were excluded. Recurrence-free survival (RFS) and specific survival (CSS) were estimated using the Kaplan-Meier method. Prognostic factors of CSS were sought by univariate and multivariate Cox regression analyzes.

Results

Forty-eight patients were included. Mean tumor size was 40.8 mm. Histology of the primary tumor was clear cell renal cancer in most cases (94.8%). Metastases were unique in 77% of patients. Metastases were metachronous in 77% of cases and occurred after a mean interval of 8.1 months. The average hospital stay was 5.4 days. The rate of positive margins was 9%. The complication rate was 23.9% but with only three major complications (Clavien> 2; 6.2%). After a median follow up of 23 months, Estimated RFS and CSS rates at 5 years were 18.3% and 97.5% respectively. The only prognostic factor associated with CSS was the absence of other metastases at the time of adrenalectomy (OR = 6.1; p = 0.03).

Conclusions

In this multicenter study, adrenalectomy for adrenal metastasis of RCC offered satisfactory perioperative outcomes. Recurrence of disease was relatively common (5 year-RFS: 18.3%; only prognostic factor = single metastasis) but CSS was similar to those observed after partial nephrectomy for small renal tumors (5 year-CSS: 97.5%).

Funding

none