Surgical Management of Isolated Adrenal Metastases: A Retrospective Comparative Study of Open, Laparoscopic, and Robotic Adrenalectomy

Background: Isolated adrenal metastases may occur in several solid malignancies, and surgical resection has been associated with improved local control and potential survival benefit in carefully selected patients. Open adrenalectomy has traditionally been considered the standard approach, while laparoscopic adrenalectomy has progressively gained acceptance as a minimally invasive alternative. More recently, robotic adrenalectomy has been introduced. However, its role in the management of adrenal metastases remains incompletely defined. Methods: This retrospective comparative study analyzed a prospectively maintained database including patients who underwent adrenalectomy for isolated adrenal metastasis between January 2001 and December 2025 at two academic centers. Patients were stratified according to surgical approach into open, laparoscopic, and robotic groups. Perioperative outcomes, postoperative morbidity, resection margin status, and oncological adequacy of the resection were compared among groups. Results: A total of 89 patients underwent adrenalectomy for isolated adrenal metastasis (robotic n = 27, laparoscopic n = 28, open n = 34). Metastasis size was larger in the robotic group compared with the laparoscopic group (51.4 vs. 44.2 mm, p = 0.043). Laparoscopy showed the shortest operative time, with respect to both robotic (p = 0.042) and open surgery (p = 0.045). Estimated blood loss was significantly higher in the open group (263 mL) than in the robotic (117 mL) and laparoscopic groups (106 mL) (p = 0.042 and 0.040, respectively). R0 resection rates were comparable across approaches (96%, 89%, and 94%, respectively). Hospital stay was shorter after both robotic and laparoscopic surgery with respect to open surgery (2.5–3.1 vs. 5.6 days, p = 0.043 and 0.046, respectively). Conclusions: Open, laparoscopic, and robotic adrenalectomy are all feasible surgical options for isolated adrenal metastases with acceptable perioperative outcomes. Robotic adrenalectomy may represent a potential extension of the applicability of minimally invasive surgery.