XXXX selection for laparoscopic excision of adrenal metastases: A multicenter cohort study.

@entity1 @entity1358 @entity5 @entity260
INTRODUCTION: The use of laparoscopy for the excision of adrenal metastasis remains controversial. We aimed to report oncological and perioperative outcomes of laparoscopic excision of adrenal metastases and to seek for predictive factors of unfavorable oncological outcomes. METHODS: A retrospective chart review was conducted and all consecutive @entity1 who underwent laparoscopic adrenalectomy (LA) in the setting of @entity5 in two academic urology departments from November 2006 through January 2014 were included. @entity5 were categorized as pulmonary, renal or "other primary" @entity5 to allow statistical comparison. Unfavorable surgical outcomes were defined as the occurrence of either @entity260 and/or positive surgical margins. RESULTS: Forty-three @entity1 who underwent a total of 45 LA were included for analysis. There were 8 complications (17.8%). Positive surgical margins were found in 12 specimens (26.7%). After a median follow-up of 37 months, estimated overall survival rates were 89.5% and 51.5% at 1 year and 5 years, respectively. In multivariable analysis the only predictor of unfavorable surgical outcomes was a @entity5 size >5  cm (OR  =  20.5; p  =  0.001). In multivariate analysis the pulmonary (OR  =  0.3; p  =  0.008) or "other" (OR  =  0.1; p  =  0.0006) origin of the @entity5 was the only prognostic factor of @entity5 specific survival. CONCLUSION: Laparoscopic resection of adrenal metastasis can be safely performed in most @entity1 but is associated with an increased risk of positive surgical @entity260 in @entity5 (>5  cm). Adrenalectomy provides better oncological outcomes in metastases from @entity1358 compared to other @entity5 .
