Adrenalectomy for metastasis: Outcomes after centralising care

Background Adrenal care in our region (catchment area 4 million) was centralised after developing a formal adrenal-MDT in 2019, backed by the ESES centralisation statement. There is a rise in adrenal surgery as part of multimodal treatment for metastatic cancer. We reviewed outcomes over the past 14 years. Method From prospective pathology and adrenal-MDT databases, 44 patients who underwent adrenalectomy for metastasis between October 2011 and October 2025 were identified. Clinical and short-term outcome data were evaluated. Results Twenty-six adrenalectomies (59.1%) were performed before 2019 and 18(40.9%) ≥2019, none in 2020. Majority were male (25;56.8%), median age at adrenalectomy was 66years[range:29-81]. Commonest primary was RCC(n=13;29.5%); followed by lung(n=10;22.7%) and melanoma(n=9;20.5%). Left-sided metastases were more frequent (n=28;63.6%), 2(4.5%) were bilateral. Twenty-one underwent an endoscopic procedure (laparoscopic: n=9;20.5%/retroscopic: n=12;27.3%), while 7(15.9%) were converted and 16(36.4%) were planned open. Rates were similar before and ≥2019 (p>0.05). Before 2019, adrenalectomies were performed by Endocrine Surgery (n=12;46.2%); Urology (n=9;34.6%); HPB (n=4;15.4%) and Upper-GI (n=1;3.8%). After 2019, all but one (94.4%) were by Endocrine Surgery (p=0.001). Overall length of stay was 4 days [1-35]; similar for both timeframes (p>0.05). Rates of complications (<2019:46.2% versus ≥2019:50.0%; p>0.05) remained similar. There was a near-significant trend: more patients received a peri-operative blood transfusion before 2019 (n=2;7.7%) versus ≥2019 (none), while 5(19.2%) developed major complications before 2019 versus none ≥2019. Conclusion These results from centralisation could be impacted byCoVid-19. Further improvements of outcomes are to be expected with the centralised adrenal referral pathway and adrenalectomies being performed by specialised teams.