V06-05: Robot-Assisted Adrenalectomy for Recurrent Metastatic Renal Cell Cancer in Non-Virgin Abdomens: The City of Hope Experience
The positive role of metastasectomy for metastatic renal cell cancer (mRCC) has been well established. The role of minimally invasive surgery (MIS) in the recurrent setting is less clear given the perceived difficulties often associated with non-virgin abdomens. We present our experience with robotic-assisted (RA) adrenalectomy for recurrent mRCC in patients with prior abdominal surgeries.
A retrospective review was performed of all patients undergoing RA adrenalectomy at City of Hope between 2012-Present. Of these, all patients undergoing this surgery for recurrent mRCC were identified. Demographic, peri-operative and follow-up data were collected in an IRB-approved database.
A total of 11 patients underwent RA adrenalectomy for recurrent mRCC. The mean age was 61.7 years and 72.7% of the cohort was male. The mean BMI was 28.3 kg/m2 and the median ASA was 3. Ten patients underwent unilateral adrenalectomy and one patient underwent bilateral adrenalectomy. All patients had a prior diagnosis of clear cell RCC and the mean interval from the initial nephrectomy to adrenalectomy was 53.5 months. The median number of prior abdominal surgeries was 2. The mean operative time was 214.2 minutes and the mean estimated blood loss was 92.3 cc. There was one open conversion. There were no transfusions or peri-operative complications. The mean length of stay was 2.4 days. The mean follow-up was 25 months. 45.5% of patients developed radiographic recurrence, and the mean time to recurrence was 18.4 months. Of the 10 patients that were followed, 1 (10%) is deceased.
RA adrenalectomy for recurrent mRCC is safe and effective even in patients with multiple prior abdominal surgeries. It is associated with an excellent peri-operative profile and data regarding recurrence is promising at intermediate follow-up. Further research is needed to establish the long-term oncologic benefit in this cohort.