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Naspro et al. Mini-invasive Surg 2021;5:50 https://dx.doi.org/10.20517/2574-1225.2021.77 Page 3 of 6

Figure 1. CT scan showing the adrenal solid expansive lesion (30 mm × 20 mm) mass and left empty renal lodge. CT: Computed
tomography.

Figure 2. The 2.5 cm incision at the tip of the 12th rib and single-site gel port GelPOINT® Advanced Access Platform (Applied Medical,
Rancho Santa Margarita, CA, USA).

Results surgical procedure
Total surgery time was 92 min. The patient had no perioperative complications and was discharged on
Postoperative Day 3. The final histological report revealed an adrenal CRCC metastasis with positive
immunophenotype for vimentin CD10, CAM5.2, and CKAE1/AE3 and negative immunophenotype for
CK7, CD117, and inhibin.

DISCUSSION
[2]
CRCC metastases occur during follow-up in about 1/3 of patients . Typical locations of metastases are
brain, lungs, bones, liver, and adrenals. The optimal treatment for locally recurrent RCC is still under
debate, and, according to EAU guidelines, surgical treatment for recurrent disease must be offered when
technically feasible, when complete resection of the mass is achievable, and in the lack of major
comorbidities . However, in the era of targeted molecular therapies, surgical metastasectomy, when
[1]
[3]
feasible, remains the gold-standard treatment, with five-year cancer specific survival of 60% . Indeed,
systemic immunotherapies with interferon and interleukin-2 (IL-2), or more recent therapies with
multikinase inhibitors (sorafenib, sunitinib, pazopanib, axitinib, lenvatinib, and cabozantinib), mTOR
inhibitors (temsirolimus and everolimus), monoclonal antibody against the eGFR (bevacizumab), and
immunomodulatory drugs (nivolumab, ipilimumab, atezolizumab, pembrolizumab, and avelumab), alone
or in combination, have been shown to improve survival and oncological results with complete responses in
less than 10% of patients and are burdened by frequent and occasionally severe toxicity . Moreover, many
[6]
studies have shown a significant increase in cancer specific survival and median overall survival in patients