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

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.