The role of positron emission tomography in selecting patients with metastatic cancer for adrenalectomy

Metastases to the adrenal glands usually signal disseminated disease. Howev er, isolated metastases do occur that may be curable with adrenalectomy. Fu nctional imaging with positron emission tomography (PET) can differentiate benign from malignant pathology and isolated from disseminated metastases. The purpose of this study was to determine whether PET scanning can influen ce the outcome of adrenalectomy for metastatic disease. We conducted a retr ospective review of eight patients undergoing adrenalectomy for presumed is olated metastatic disease from 1985 through 1997. The patients included six women and two men with an average age of 58 (range, 36-74). Their primary tumors were six lung carcinomas, one renal cell carcinoma, and one colon ca rcinoma. The adrenal masses were located on the right in six patients, on t he left in one, and bilaterally in one. Before operation, all patients were evaluated by chest and abdominal CT. Four patients were also evaluated by PET scan. Six right, one left, and one bilateral adrenalectomies were perfo rmed. Associated organ resections included two right partial nephrectomies and one right total nephrectomy, one left partial nephrectomy, two distal p ancreatectomies, one splenectomy, and two partial hepatic resections. All e ight patients survived operation. There were no major perioperative complic ations, but one patient required readmission for congestive heart failure. Three of the four patients who did not have PET scanning died from 4 to 48 months after operation with disseminated disease from lung, colon, and rena l carcinoma respectively. The remaining patient who did not have PET scanni ng is alive and well II years later, Two of the four patients who had PET s cans showing isolated disease are alive at 28 and 43 months after operation , whereas the other two died of disseminated disease at 29 and 36 months af ter operation. We conclude that I) adrenalectomy can provide survival benef it in patients with isolated metastases, and 2) PET scanning is useful in c onfirming isolated metastatic disease and selecting patients for adrenalect omy.