Surgical Treatment of Lung Cancer With Synchronous Adrenal Metastases: Adrenalectomy First

• Published in: Cirugia española (English ed.) Vol. 95; no. 2; pp. 97 - 101
• Main Authors: Pardo Aranda, Fernando, Larrañaga Blanc, Itziar, Rivero Déniz, Joaquín, Trujillo, Juan Carlos, Rada Palomino, Arantxa, García-Olivares, Esteban, Rami Porta, Ramón, Veloso, Enrique Veloso
• Format: Journal Article
• Language: English
• Published: Elsevier España 01.02.2017
• Subjects: Adrenalectomy first; Adrenalectomía primero; Carcinoma pulmonar no microcítico; Metástasis suprarrenal sincrónica; Non-small cell lung cancer; Oligometastases; Oligometástasis; Surgery; Synchronous adrenal metastases; Synchronous adrenal metastases; Oligometastases; Non-small cell lung cancer; Adrenalectomy first; Oligometástasis; Carcinoma pulmonar no microcítico; Metástasis suprarrenal sincrónica; Adrenalectomía primero
• ISSN: 2173-5077; 2173-5077
• DOI: 10.1016/j.cireng.2017.03.008

Abstract Introduction The aim of this study is to present our patients with lung cancer and synchronous adrenal metastases treated with a reversal approach: starting with adrenalectomy and doing the lung resection second. Methods A total of 108 laparoscopic adrenalectomies were performed, and we analyze a consecutive series of 10 patients with isolated adrenal synchronous metastases from the lung, surgically treated in a sequential way. All patients underwent staging mediastinoscopy, and patients with positive lymph nodes were primary treated with chemotherapy. We analyze: postoperative morbidity, length of stay, time between the 2 surgeries, survival free progression and global survival. Survival analysis was performed by the Kaplan–Meier method. Results Mean age: 56.8 (41–73) years old. Of the total, 8 patients were surgically performed by laparoscopy. Metastases average size: 5.9 (3–10) cm. Days between the 2 surgeries were 28 (12–35) days. No morbidity after adrenalectomy. Length of stay was 4.3 (3–5) days. Disease-free survival at 2 years was 60%, the 5-year overall survival was 30%, with a median survival of 41.5 (0–98) months. Conclusions Adrenalectomy involves no significant morbidity and can be performed safely without delaying lung surgery, and allows us to operate the primary lung tumor successfully as long as we ensure complete resection of the adrenal gland. A multidisciplinary oncology committee must individualize all cases and consider this therapeutic approach in all patients with resectable primary tumor and resectable adrenal metastases.