[Diagnosis and therapy of metastatic tumors in the adrenal gland--a report of 21 cases].

Background & Objective: Recently, the occurrence of metastasis to the adrenal gland is increasing, while the early and differentiated diagnosis still remains difficult. Whether metastasis to the adrenal gland needs to be resected and when and how the resection should be done are controversial. This study was to explore the surgical indications of metastasis to the adrenal gland and the role of laparoscopic adrenalectomy in the treatment of this disease.

Methods: Clinical data of 21 patients with metastatic tumors in the adrenal gland, treated in Cancer Center of Sun Yat-sen University from Mar. 1997 to Mar. 2004, were analyzed retrospectively. Literature of the diagnosis and therapy was reviewed.

Results: The diagnosis rates of ultrasonography and spiral or thin-cut computed tomography (CT) were 70.0% (7/10) and 84.6% (11/13). Ten patients received adrenalectomy with negative resection margins, 4 of them received laparoscopic adrenalectomy. The patients survived for 1-67 months, with a median of 18 months. One patient was still alive 67 months after the adrenalectomy, and 2 was lost. Eleven patients received palliative operation or no treatment, 10 of them survived for 5-28 months with a median of 13 months, while 1 was lost during follow-up. The difference in survival rates between the 2 groups was not significant (P=0.346).

Conclusions: Ultrasonography and CT are important diagnosis methods for metastatic adrenal cancer. No evidence of tumor invasion revealed by preoperative imaging studies, no adjacent lymphadenopathy and no extraladrenal metastasis are indications of adrenalectomy. Laparoscopic adrenalectomy is safe and effective for those well-selected patients.