Surgical Resection of Isolated Adrenal Metastases in Patients with Non-Small Cell Lung Cancer: A Single-Institution Experience and Review of the Literature

Abstract

Background: In non-small cell lung cancer (NSCLC), the benefits of resection of solitary adrenal metastases for survival and the identification of patients most likely to benefit from adrenalectomy are unknown. Patients and Methods: We retrospectively reviewed clinico-pathological factors and outcomes in 4 NSCLC patients treated with adrenalectomy at our centre. We reviewed the published literature with a focus on long-term survivors in order to formulate treatment recommendations. Results: Local pathological staging showed stages IA–IIA. All had a performance status (PS) of 0. The median age was 56 years (range: 53–58 years). Adrenal metastases were detected by positron emission tomography-computed tomography (PET-CT) in 3 patients. Median time from lobectomy to occurrence of metachronous adrenal metastases was 12.3 months (11–14 months). The perioperative mortality was zero. All patients recurred systemically after adrenalectomy within 2–49 months. 3 patients died due to systemic progression 6–15 months after adrenalectomy. 1 patient is alive with pulmonary relapse 49 months after adrenalectomy. Conclusions: Resection of solitary adrenal metastases in selected good-PS NSCLC patients with minimal local nodal involvement from the primary tumour is associated with low morbidity and may offer a chance for long-term disease-free survival in a small subset of patients. Careful pre-operative staging including PET-CT is warranted.

Current surgical management of extrapulmonary oligometastatic non-small cell lung carcinoma

“…None of the differences were significant; and the estimated overall survival was 33.4 ± 5.2 months [47]. Beside those studies, some other series in which small groups of patients were evaluated, also offers adrenalectomy in selected NSCLC patients who have good performance status and with minimal local nodal involvement from primary tumor [48,49]. Adrenalectomy for metastatic NSCLC patients is associated with low morbidity and may offer a chance for long-term disease-free survival.…”

Laparoscopy versus open adrenalectomy in patients with solid tumor metastases: results of a multicenter European study

“…Several studies have reported that adrenalectomy improves outcome in selected patients with metastatic disease, particularly in cases of isolated lesions and metachronous metastasis (1)(2)(3)(4)(5)(6). In patients with isolated adrenal metastases, a more favourable survival for adrenal resection has been reported as compared with nonoperative approaches (7,8).…”