Combined robotic lobectomy and adrenalectomy for lung cancer and solitary adrenal metastasis.
OBJECTIVE
Surgical resection of isolated adrenal metastasis in primary lung cancer is associated with improved survival. We report a combined robotic lobectomy and adrenalectomy for resection of a primary lung cancer and metastasis to the adrenal gland.


METHODS
A 69-year-old male with a significant smoking history and shortness of breath was found to have a 3-cm left upper lobe mass with an enlarged left adrenal gland measuring 1.5cm. The adrenal gland was biopsied confirming metastatic poorly differentiated carcinoma, likely lung cancer. Computed  tomography, positron emission tomography, and mediastinoscopy revealed no evidence of disease outside the adrenal gland.


RESULTS
Following induction chemotherapy, the patient underwent combination robotic lobectomy, lymphadenectomy, and adrenalectomy while in the same lateral decubitus  position. Thoracic and urologic oncology teams performed their respective portions of the operation. Overall operative time was 4 hours, and length of hospital stay was 3 days. Estimated blood loss was 150mL with no narcotic requirements beyond the first postoperative day. Final pathology  revealed large cell carcinoma of the lung with metastasis to the adrenal. All surgical margins were negative.


CONCLUSIONS
Combination robotic lobectomy and adrenalectomy is feasible and can be associated with a short convalescence, minimal pain, and an oncologically sound approach.
City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA. byuh@coh.org
Bertram
B
Yuh
Clayton
C
Lau
Kemp
K
Kernstine
D000310:Adrenal Gland Neoplasms / Q000556:secondary / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000368:Aged; D018287:Carcinoma, Large Cell / Q000556:secondary / Q000601:surgery*; D005240:Feasibility Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision; D008297:Male; D011013:Pneumonectomy / Q000379:methods*; D012371:Robotics / Q000379:methods*