Laparoscopic adrenalectomy for solitary adrenal metastasis from lung cancer.
OBJECTIVE
Several studies have been reported on the problem of determining when laparoscopic adrenalectomy is indicated for solitary adrenal metastasis of malignant tumors. Our efforts at answering this question constitute the basis of this report.


METHODS
From June 2010 to June 2011, laparoscopic adrenalectomy was performed in 10 lung cancer patients with solitary adrenal metastases (5 adenocarcinomas, 1 squamous cell carcinoma, 1 large cell carcinoma, 1 small cell carcinoma, and 2 pleomorphic carcinomas). The surgical results of all 10 patients were examined.


RESULTS
Adrenal swelling was detected by computed tomography in all patients except 1 case of pleomorphic carcinoma. The findings of positron emission tomography-computed tomography were positive in 8 patients, including the 2 cases with pleomorphic carcinomas. Laparoscopic surgery was successfully performed in 9 cases. In the eighth patient (a case of pleomorphic carcinoma with adrenal swelling), laparoscopic adrenalectomy was attempted but conversion to open surgery was required because of clear evidence of pancreatic invasion.


CONCLUSIONS
The results obtained in this study, along with other published reports, support 4 criteria as operative indications for laparoscopic adrenalectomy in solitary adrenal metastasis from the lung: (1) the primary lung cancer is resected or can be cured by radical chemotherapy, (2) metastasis is limited to the adrenal gland only, (3) adrenal metastasis does not invade the surrounding organs, and (4) the size of the adrenal tumor does not exceed 10 cm. In cases of pleomorphic carcinoma, laparoscopic adrenalectomy should be performed when positron emission tomography-computed tomography results are positive.
Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Noriyasu
N
Kawai
Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Keiichi
K
Tozawa
Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Takahiro
T
Yasui
Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Yoshinobu
Y
Moritoki
Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Hidefumi
H
Sasaki
Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Motoki
M
Yano
Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Yoshitaka
Y
Fujii
Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Kenjiro
K
Kohri
D000230:Adenocarcinoma / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000368:Aged; D061887:Conversion to Open Surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed
Adrenal metastasis; Laparoscopic adrenalectomy; Lung cancer; Pleomorphic carcinoma