A Retrospective Study to Assess Survival Post-adrenal Metastasectomy in Our Regional Endocrine Surgery Unit.

AIM: The aim was to assess survival in patients post-adrenalectomy for metastasis from a non-adrenal primary.  Method: We reviewed our local database for all patients who underwent adrenalectomy for the indication of metastasis from January 2019 to December 2024 (27 cases). We then excluded patients with pathology results showing a non-metastatic lesion (four patients) and patients in whom adrenalectomy was unsuccessful (three patients). This left us with 20 patients who successfully underwent an adrenal metastasectomy. Eleven of the patients had primary lung tumors, four melanomas, two renal, two colon and one breast.  Results: Of the 20 cases the median age was 65.6 years, 13 patients were female and the median length of stay was one day. Ten operations were performed laparoscopically, six robotically and four open. The median tumor size was 3.5cm (1.6-12cm). There was one reported complication of intraoperative bleeding but the patient did not require a blood transfusion. Twelve patients went on to have further systemic treatment postoperatively.  A Kaplan-Meier survival analysis was performed, resulting in a one-year overall survival (OS) of 86%, three-year of 52% and five-year of 43%. The overall survival and progression-free survival (PFS) were worse for patients with lung cancer primaries than other primaries (three-year OS 25% vs 64% three-year PFS 0% vs 67%).  Conclusion: Our unit's post-operative survival is in line with the currently available data around survival post-adrenal metastasectomy. Lung cancer primary, as an indication for surgery, was more prevalent than expected in this data set. This high prevalence, coupled with the difference in OS and PFS between lung and non-lung primary, is noteworthy and warrants further investigation.