The non-responding adrenal metastasis in melanoma: The case for minimally invasive adrenalectomy in the age of modern therapies

Douglas Zippel, Tal Yalon, Yehonatan Nevo, Gal Markel, Nethanel Asher, Jacob Schachter, David Goitein, Tamar Abramovich Segal, Aviram Nissan, David Hazzan

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Minimally invasive adrenalectomy has facilitated resection of resistant adrenal metastases. The adrenal gland may function as a sanctuary site for metastatic growth despite systemic therapy. The objective of the study was to assess the outcomes of selective minimally invasive adrenalectomy during immunotherapy. Methods: Candidates included patients with adrenal metastases resistant to systemic therapy who underwent minimally invasive adrenalectomy. Results: There were 15 patients undergoing 16 minimally invasive adrenalectomies. Patients received either immunotherapy or BRAF inhibition prior to surgery. The mean operative time was 130 min with a median length of hospital stay of 2 days. At a median follow up of 24 months, 7 patients have no evidence of disease, 6 patients had progression with eventual mortality, while another patients has stable disease with maintenance therapy. One was lost to follow up. Conclusion: Despite an increase in objective durable responses in metastatic melanoma, there is still some site-specific resistance in isolated areas like the adrenal where early minimally invasive adrenalectomy remains indicated.

Original languageEnglish
Pages (from-to)349-353
Number of pages5
JournalAmerican Journal of Surgery
Volume220
Issue number2
DOIs
StatePublished - Aug 2020

Keywords

  • Adrenal gland
  • Metastatic melanoma
  • Minimally invasive surgery

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