Surgical treatment of lung cancer with synchronous adrenal metastases: Adrenalectomy first. / Tratamiento quirúrgico de metástasis suprarrenal sincrónica de cáncer de pulmón: adrenalectomía primero.

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 serie 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 2surgeries, suvival 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 2surgeries 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.

Tratamiento quirúrgico de metastasis suprarrenal sincrónica de cáncer de pulmón: adrenalectomía primero / Surgical treatment of lung cancer with synchronous adrenal metastases: adrenalectomy first

INTRODUCCIÓN: El objetivo de este estudio es presentar nuestra serie de pacientes con carcinoma pulmonar y metástasis única suprarrenal sincrónica tratados de manera secuencial inversa: primero adrenalectomía y después resección pulmonar. MÉTODOS: Del total de 108 adrenalectomías laparoscópicas transperitoneales realizadas se analiza de manera retrospectiva una serie consecutiva de 10 pacientes diagnosticados de tumor primario de pulmón con metástasis suprarrenal sincrónica tratados de manera secuencial inversa. A todos se les realizó mediastinoscopia de estadificación; aquellos con metástasis ganglionares recibieron inducción. Las variables analizadas fueron: morbilidad tras adrenalectomía y tras resección pulmonar, estancia hospitalaria, tiempo entre ambas intervenciones, intervalo libre de enfermedad y supervivencia global. La supervivencia se analizó según el método de Kaplan-Meier. RESULTADOS: Edad media: 56,8 años (rango: 41-73). Del total, 8 casos se intervinieron por laparoscopia. Tamaño medio de la metástasis: 5,9cm (rango: 3-10). Tiempo medio entre ambas intervenciones: 28 días (rango: 12-35). No hubo complicaciones tras la adrenalectomía. Estancia media: 4,3 días (rango: 3-5). La supervivencia libre de enfermedad a los 2años fue del 50% y la supervivencia global a los 5 años fue del 30%, con una supervivencia global mediana de 41,5 meses (rango: 0-98). CONCLUSIONES: La adrenalectomía para metástasis de carcinoma pulmonar tiene baja morbilidad, no retrasa la resección del tumor primario y permite realizar la resección pulmonar una vez asegurada la resección completa de la metástasis. Por tanto, a falta de ensayos clínicos, un comité multidisciplinar debe considerar de forma individualizada esta opción terapéutica para todos aquellos pacientes en quienes la estadificación clínica de su carcinoma indique que tanto el tumor primario como la metástasis pueden extirparse de forma completa

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 serie 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 2surgeries, suvival 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 2surgeries 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