Laparoscopic adrenalectomy for solitary metachronous contralateral adrenal metastasis from renal cell carcinoma

Purpose: We report our experience with laparoscopic adrenalectomy for malignant adrenal disease. Materials and Methods: Between June 1995 and January 1996, 2 patients with a solitary metachronous contralateral adrenal metastasis from renal cell cancer were evaluated. Both patients had undergone radical nephrectomy for localized renal cancer 5 years previously, Laparoscopic transperitoneal adrenalectomy was performed. Results: The laparoscopic procedures required 2.5 and 4.3 hours. Hospital stay was 3 and 4 days. The specimens weighed 98 and 81 gm. All surgical margins were free of metastatic clear cell cancer. Both patients were begun on prednisone and fludrocortisone replacement therapy. One patient experienced an increase in creatinine, which has since stabilized at 3.0 mg./dl. Neither patient had recurrent cancer at 11 and 16 months of followup. Conclusions: Laparoscopic adrenalectomy for metastatic renal cell cancer was performed successfully in 2 patients. However, the short-term benefits to the patient of earlier ambulation, decreased pain, minimal incisions and shortened convalescence must be weighed against the as yet unknown long-term (5 years) results.