Resection Versus Observation for Adrenal Gland Metastasis

  • Frédéric Mercier
  • Liane S. Feldman
  • Elliot J. MitmakerEmail author
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)


The adrenal glands are frequently the site of metastasis from several different types of cancers, including lung, breast, melanoma, renal cell, and colon. Traditionally, the finding of adrenal metastasis was believed to portend end-stage disease and consequently surgery was rarely performed. Since the introduction of laparoscopic adrenalectomy in 1992, resection for isolated adrenal metastases is being reported with increasing frequency, and several authors have even reported improved outcomes and survival in selected patients. Presently the evidence for this recommendation is based solely on published anecdotal reports and retrospective series. Hence prospective studies are desperately needed so that formal guidelines can be established in the decision-making process for patients with adrenal metastases.


Adrenal metastases Oligometastases Stereotactic ablative body radiotherapy Adrenalectomy Laparoscopic adrenalectomy Radiofrequency ablation 


  1. 1.
    Abrams HL, Spiro R, Goldstein N. Metastases in carcinoma; analysis of 1000 autopsied cases. Cancer. 1950;3(1):74–85.CrossRefPubMedGoogle Scholar
  2. 2.
    Bullock WK, Hirst AE. Metastatic carcinoma of the adrenal. Am J Med Sci. 1953;226(5):521–4.CrossRefPubMedGoogle Scholar
  3. 3.
    Onuigbo WI. Lymphangiogenesis may explain adrenal selectivity in lung cancer metastases. Med Hypotheses. 2010;75(2):185–6.CrossRefPubMedGoogle Scholar
  4. 4.
    McLean K, Lilienfeld H, Caracciolo JT, Hoffe S, Tourtelot JB, Carter WB. Management of isolated adrenal lesions in cancer patients. Cancer Control. 2011;18(2):113–26.CrossRefPubMedGoogle Scholar
  5. 5.
    Gunjur A, Duong C, Ball D, Siva S. Surgical and ablative therapies for the management of adrenal ‘oligometastases’ - a systematic review. Cancer Treat Rev. 2014;40(7):838–46.CrossRefPubMedGoogle Scholar
  6. 6.
    Kulke MH, Shah MH, Benson AB, Bergsland E, Berlin JD, Blaszkowsky LS, et al. Neuroendocrine tumors, version 1.2015. J Natl Compr Cancer Netw. 2015;13(1):78–108.CrossRefGoogle Scholar
  7. 7.
    Lam KY, Lo CY. Metastatic tumours of the adrenal glands: a 30-year experience in a teaching hospital. Clin Endocrinol. 2002;56(1):95–101.CrossRefGoogle Scholar
  8. 8.
    Liu XJ, Shen P, Wang XF, Sun K, Sun FF. Solitary adrenal metastasis from invasive ductal breast cancer: an uncommon finding. World J Surg Oncol. 2010;8:7.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Lenert JT, Barnett CC, Kudelka AP, Sellin RV, Gagel RF, Prieto VG, et al. Evaluation and surgical resection of adrenal masses in patients with a history of extra-adrenal malignancy. Surgery. 2001;130(6):1060–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Sancho JJ, Triponez F, Montet X, Sitges-Serra A. Surgical management of adrenal metastases. Langenbeck’s Arch Surg. 2012;397(2):179–94.CrossRefGoogle Scholar
  11. 11.
    Lee JE, Evans DB, Hickey RC, Sherman SI, Gagel RF, Abbruzzese MC, Abbruzzese JL. Unknown primary cancer presenting as an adrenal mass: frequency and implications for diagnostic evaluation of adrenal incidentalomas. Surgery. 1998;124(6):1115–22.CrossRefPubMedGoogle Scholar
  12. 12.
    Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol. 1995;13(1):8–10.CrossRefPubMedGoogle Scholar
  13. 13.
    Raynaud CM, Mercier O, Dartevelle P, Commo F, Olaussen KA, de Montpreville V, et al. Expression of chemokine receptor CCR6 as a molecular determinant of adrenal metastatic relapse in patients with primary lung cancer. Clin Lung Cancer. 2010;11(3):187–91.CrossRefPubMedGoogle Scholar
  14. 14.
    Blake MA, Holalkere NS, Boland GW. Imaging techniques for adrenal lesion characterization. Radiol Clin N Am. 2008;46(1):65–78. vi.CrossRefPubMedGoogle Scholar
  15. 15.
    Caoili EM, Korobkin M, Francis IR, Cohan RH, Platt JF, Dunnick NR, Raghupathi KI. Adrenal masses: characterization with combined unenhanced and delayed enhanced CT. Radiology. 2002;222(3):629–33.CrossRefPubMedGoogle Scholar
  16. 16.
    Haider MA, Ghai S, Jhaveri K, Lockwood G. Chemical shift MR imaging of hyperattenuating (>10 HU) adrenal masses: does it still have a role? Radiology. 2004;231(3):711–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Metser U, Miller E, Lerman H, Lievshitz G, Avital S, Even-Sapir E. 18F-FDG PET/CT in the evaluation of adrenal masses. J Nucl Med. 2006;47(1):32–7.PubMedGoogle Scholar
  18. 18.
    Lee JE, Evans DB, Sherman SI, Gagel RF. Evaluation of the incidental adrenal mass. Am J Med. 1997;103(3):249–50.CrossRefPubMedGoogle Scholar
  19. 19.
    Mercier O, Fadel E, de Perrot M, Mussot S, Stella F, Chapelier A, Dartevelle P. Surgical treatment of solitary adrenal metastasis from non-small cell lung cancer. J Thorac Cardiovasc Surg. 2005;130(1):136–40.CrossRefPubMedGoogle Scholar
  20. 20.
    Tanvetyanon T, Robinson LA, Schell MJ, Strong VE, Kapoor R, Coit DG, Bepler G. Outcomes of adrenalectomy for isolated synchronous versus metachronous adrenal metastases in non-small-cell lung cancer: a systematic review and pooled analysis. J Clin Oncol. 2008;26(7):1142–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Sugimura H, Nichols FC, Yang P, Allen MS, Cassivi SD, Deschamps C, et al. Survival after recurrent nonsmall-cell lung cancer after complete pulmonary resection. Ann Thorac Surg. 2007;83(2):409–17. discussion 417-8.CrossRefPubMedGoogle Scholar
  22. 22.
    Haigh PI, Essner R, Wardlaw JC, Stern SL, Morton DL. Long-term survival after complete resection of melanoma metastatic to the adrenal gland. Ann Surg Oncol. 1999;6(7):633–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Mittendorf EA, Lim SJ, Schacherer CW, Lucci A, Cormier JN, Mansfield PF, et al. Melanoma adrenal metastasis: natural history and surgical management. Am J Surg. 2008;195(3):363–8. discussion 368-9.CrossRefPubMedGoogle Scholar
  24. 24.
    Sarela AI, Murphy I, Coit DG, Conlon KC. Metastasis to the adrenal gland: the emerging role of laparoscopic surgery. Ann Surg Oncol. 2003;10(10):1191–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Strong VE, D'Angelica M, Tang L, Prete F, Gönen M, Coit D, et al. Laparoscopic adrenalectomy for isolated adrenal metastasis. Ann Surg Oncol. 2007;14(12):3392–400.CrossRefPubMedGoogle Scholar
  26. 26.
    Moreno P, de la Quintana BA, Musholt TJ, Paunovic I, Puccini M, Vidal O, et al. Adrenalectomy for solid tumor metastases: results of a multicenter european study. Surgery. 2013;154(6):1215–22. discussion 1222-3.CrossRefPubMedGoogle Scholar
  27. 27.
    Guckenberger M, Andratschke N, Alheit H, Holy R, Moustakis C, Nestle U, et al. Definition of stereotactic body radiotherapy: principles and practice for the treatment of stage I non-small cell lung cancer. Strahlenther Onkol. 2014;190(1):26–33.CrossRefPubMedGoogle Scholar
  28. 28.
    Onishi H, Araki T, Shirato H, Nagata Y, Hiraoka M, Gomi K, et al. Stereotactic hypofractionated high-dose irradiation for stage I nonsmall cell lung carcinoma: clinical outcomes in 245 subjects in a japanese multiinstitutional study. Cancer. 2004;101(7):1623–31.CrossRefPubMedGoogle Scholar
  29. 29.
    Branum GD, Epstein RE, Leight GS, Seigler HF. The role of resection in the management of melanoma metastatic to the adrenal gland. Surgery. 1991;109(2):127–31.PubMedGoogle Scholar
  30. 30.
    Lo CY, van Heerden JA, Soreide JA, Grant CS, Thompson GB, Lloyd RV, Harmsen WS. Adrenalectomy for metastatic disease to the adrenal glands. Br J Surg. 1996;83(4):528–31.CrossRefPubMedGoogle Scholar
  31. 31.
    Wade TP, Longo WE, Virgo KS, Johnson FE. A comparison of adrenalectomy with other resections for metastatic cancers. Am J Surg. 1998;175(3):183–6.CrossRefPubMedGoogle Scholar
  32. 32.
    Heniford BT, Arca MJ, Walsh RM, Gill IS. Laparoscopic adrenalectomy for cancer. Semin Surg Oncol. 1999;16(4):293–306.CrossRefPubMedGoogle Scholar
  33. 33.
    Harrison J, Ali A, Bonomi P, Prinz R. The role of positron emission tomography in selecting patients with metastatic cancer for adrenalectomy. Am Surg. 2000;66(5):432–6. discussion 436-7.PubMedGoogle Scholar
  34. 34.
    Bretcha-Boix P, Rami-Porta R, Mateu-Navarro M, Hoyuela-Alonso C, Marco-Molina C. Surgical treatment of lung cancer with adrenal metastasis. Lung Cancer. 2000;27(2):101–5.CrossRefPubMedGoogle Scholar
  35. 35.
    Porte H, Siat J, Guibert B, Lepimpec-Barthes F, Jancovici R, Bernard A, et al. Resection of adrenal metastases from non-small cell lung cancer: a multicenter study. Ann Thorac Surg. 2001;71(3):981–5.CrossRefPubMedGoogle Scholar
  36. 36.
    Momoi H, Shimahara Y, Terajima H, Iimuro Y, Yamamoto N, Yamamoto Y, et al. Management of adrenal metastasis from hepatocellular carcinoma. Surg Today. 2002;32(12):1035–41.CrossRefPubMedGoogle Scholar
  37. 37.
    Pfannschmidt J, Schlolaut B, Muley T, Hoffmann H, Dienemann H. Adrenalectomy for solitary adrenal metastases from non-small cell lung cancer. Lung Cancer. 2005;49(2):203–7.CrossRefPubMedGoogle Scholar
  38. 38.
    Lucchi M, Dini P, Ambrogi MC, Berti P, Materazzi G, Miccoli P, Mussi A. Metachronous adrenal masses in resected non-small cell lung cancer patients: therapeutic implications of laparoscopic adrenalectomy. Eur J Cardiothorac Surg. 2005;27(5):753–6.CrossRefPubMedGoogle Scholar
  39. 39.
    Sebag F, Calzolari F, Harding J, Sierra M, Palazzo FF, Henry JF. Isolated adrenal metastasis: the role of laparoscopic surgery. World J Surg. 2006;30(5):888–92.CrossRefPubMedGoogle Scholar
  40. 40.
    Kita M, Tamaki G, Okuyama M, Saga Y, Kakizaki H. Adrenalectomy for metastatic adrenal tumors. Hinyokika Kiyo. 2007;53(11):761–6.PubMedGoogle Scholar
  41. 41.
    Park JS, Yoon DS, Kim KS, Choi JS, Lee WJ, Chi HS, Kim BR. What is the best treatment modality for adrenal metastasis from hepatocellular carcinoma? J Surg Oncol. 2007;96(1):32–6.CrossRefPubMedGoogle Scholar
  42. 42.
    Adler JT, Mack E, Chen H. Equal oncologic results for laparoscopic and open resection of adrenal metastases. J Surg Res. 2007;140(2):159–64.CrossRefPubMedGoogle Scholar
  43. 43.
    Collinson FJ, Lam TK, Bruijn WM, de Wilt JH, Lamont M, Thompson JF, Kefford RF. Long-term survival and occasional regression of distant melanoma metastases after adrenal metastasectomy. Ann Surg Oncol. 2008;15(6):1741–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Bonnet S, Gaujoux S, Leconte M, Thillois JM, Tissier F, Dousset B. Laparoscopic adrenalectomy for metachronous metastasis from renal cell carcinoma. World J Surg. 2008;32(8):1809–14.CrossRefPubMedGoogle Scholar
  45. 45.
    Mourra N, Hoeffel C, Duvillard P, Guettier C, Flejou JF, Tiret E. Adrenalectomy for clinically isolated metastasis from colorectal carcinoma: report of eight cases. Dis Colon Rectum. 2008;51(12):1846–9.CrossRefPubMedGoogle Scholar
  46. 46.
    Marangos IP, Kazaryan AM, Rosseland AR, Røsok BI, Carlsen HS, Kromann-Andersen B, et al. Should we use laparoscopic adrenalectomy for metastases? Scandinavian multicenter study. J Surg Oncol. 2009;100(1):43–7.CrossRefPubMedGoogle Scholar
  47. 47.
    de Haas RJ, Rahy Martin AC, Wicherts DA, Azoulay D, Castaing D, Adam R. Long-term outcome in patients with adrenal metastases following resection of colorectal liver metastases. Br J Surg. 2009;96(8):935–40.CrossRefPubMedGoogle Scholar
  48. 48.
    Muth A, Persson F, Jansson S, Johanson V, Ahlman H, Wängberg B. Prognostic factors for survival after surgery for adrenal metastasis. Eur J Surg Oncol. 2010;36(7):699–704.CrossRefPubMedGoogle Scholar
  49. 49.
    Pascual Piédrola JI, Rincón Mayans A, Tolosa Eizaguirre E, Barba Abad J, Romero Vargas L, Rosell Costa D. Laparoscopic adrenalectomy for metachronous metastasis. Experience in 12 cases. Actas Urol Esp. 2010;34(2):201–5.CrossRefPubMedGoogle Scholar
  50. 50.
    Wu HY, Yu Y, Xu LW, Li XD, Yu DM, Zhang ZG, Li GH. Transperitoneal laparoscopic adrenalectomy for adrenal metastasis. Surg Laparosc Endosc Percutan Tech. 2011;21(4):271–4.CrossRefPubMedGoogle Scholar
  51. 51.
    Raz DJ, Lanuti M, Gaissert HC, Wright CD, Mathisen DJ, Wain JC. Outcomes of patients with isolated adrenal metastasis from non-small cell lung carcinoma. Ann Thorac Surg. 2011;92(5):1788–92. discussion 1793.CrossRefPubMedGoogle Scholar
  52. 52.
    Crenn G, Delaunay B, Salloum A, Vezzosi D, Bellec L, Thoulouzan M, et al. Carcinological results of laparoscopic adrenalectomy for adrenal metastasis. Prog Urol. 2011;21(9):607–14.CrossRefPubMedGoogle Scholar
  53. 53.
    Zerrweck C, Caiazzo R, Clerquin B, Donatini G, Lamblin A, El Khatib Z, et al. Renal origin and size are independent predictors of survival after surgery for adrenal metastasis. Ann Surg Oncol. 2012;19(11):3621–6.CrossRefPubMedGoogle Scholar
  54. 54.
    Katoh N, Onimaru R, Sakuhara Y, Abo D, Shimizu S, Taguchi H, et al. Real-time tumor-tracking radiotherapy for adrenal tumors. Radiother Oncol. 2008;87(3):418–24.CrossRefPubMedGoogle Scholar
  55. 55.
    Chawla S, Chen Y, Katz AW, Muhs AG, Philip A, Okunieff P, Milano MT. Stereotactic body radiotherapy for treatment of adrenal metastases. Int J Radiat Oncol Biol Phys. 2009;75(1):71–5.CrossRefPubMedGoogle Scholar
  56. 56.
    Torok J, Wegner RE, Burton SA, Heron DE. Stereotactic body radiation therapy for adrenal metastases: a retrospective review of a noninvasive therapeutic strategy. Future Oncol. 2011;7(1):145–51.CrossRefPubMedGoogle Scholar
  57. 57.
    Oshiro Y, Takeda Y, Hirano S, Ito H, Aruga T. Role of radiotherapy for local control of asymptomatic adrenal metastasis from lung cancer. Am J Clin Oncol. 2011;34(3):249–53.CrossRefPubMedGoogle Scholar
  58. 58.
    Holy R, Piroth M, Pinkawa M, Eble MJ. Stereotactic body radiation therapy (SBRT) for treatment of adrenal gland metastases from non-small cell lung cancer. Strahlenther Onkol. 2011;187(4):245–51.CrossRefPubMedGoogle Scholar
  59. 59.
    Casamassima F, Livi L, Masciullo S, Menichelli C, Masi L, Meattini I, et al. Stereotactic radiotherapy for adrenal gland metastases: university of Florence experience. Int J Radiat Oncol Biol Phys. 2012;82(2):919–23.CrossRefPubMedGoogle Scholar
  60. 60.
    Guiou M, Mayr NA, Kim EY, Williams T, Lo SS. Stereotactic body radiotherapy for adrenal metastases from lung cancer. J Radiat Oncol. 2012;1(2):155–63.CrossRefGoogle Scholar
  61. 61.
    Ahmed KA, Barney BM, Macdonald OK, Miller RC, Garces YI, Laack NN, et al. Stereotactic body radiotherapy in the treatment of adrenal metastases. Am J Clin Oncol. 2013;36(5):509–13.CrossRefPubMedGoogle Scholar
  62. 62.
    Scorsetti M, Alongi F, Filippi AR, Pentimalli S, Navarria P, Clerici E, et al. Long-term local control achieved after hypofractionated stereotactic body radiotherapy for adrenal gland metastases: a retrospective analysis of 34 patients. Acta Oncol. 2012;51(5):618–23.CrossRefPubMedGoogle Scholar
  63. 63.
    Mayo-Smith WW, Dupuy DE. Adrenal neoplasms: CT-guided radiofrequency ablationpreliminary results. Radiology. 2004;231(1):225–30.CrossRefPubMedGoogle Scholar
  64. 64.
    Carrafiello G, Laganà D, Recaldini C, Giorgianni A, Ianniello A, Lumia D, et al. Imaging-guided percutaneous radiofrequency ablation of adrenal metastases: preliminary results at a single institution with a single device. Cardiovasc Intervent Radiol. 2008;31(4):762–7.CrossRefPubMedGoogle Scholar
  65. 65.
    Wang Y, Liang P, Yu X, Cheng Z, Yu J, Dong J. Ultrasound-guided percutaneous microwave ablation of adrenal metastasis: preliminary results. Int J Hyperth. 2009;25(6):455–61.CrossRefGoogle Scholar
  66. 66.
    Mouracade P, Dettloff H, Schneider M, Debras B, Jung JL. Radio-frequency ablation of solitary adrenal gland metastasis from renal cell carcinoma. Urology. 2009;74(6):1341–3.CrossRefPubMedGoogle Scholar
  67. 67.
    Yamakado K, Anai H, Takaki H, Sakaguchi H, Tanaka T, Kichikawa K, Takeda K. Adrenal metastasis from hepatocellular carcinoma: radiofrequency ablation combined with adrenal arterial chemoembolization in six patients. AJR Am J Roentgenol. 2009;192(6):W300–5.CrossRefPubMedGoogle Scholar
  68. 68.
    Wolf FJ, Dupuy DE, Machan JT, Mayo-Smith WW. Adrenal neoplasms: effectiveness and safety of ct-guided ablation of 23 tumors in 22 patients. Eur J Radiol. 2012;81(8):1717–23.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Frédéric Mercier
    • 1
  • Liane S. Feldman
    • 2
    • 3
  • Elliot J. Mitmaker
    • 4
    Email author
  1. 1.Department of Surgical OncologyCentre Hospitalier de l’université de MontréalMontrealCanada
  2. 2.Department of SurgeryMcGill University Health CenterMontrealCanada
  3. 3.Steinberg-Bernstein Centre for Minimally Invasive Surgery and InnovationMcGill UniversityMontrealCanada
  4. 4.Department of SurgeryRoyal Victoria Hospital – Glen Site, McGill University Health CenterMontrealCanada

Personalised recommendations