title: Surgical treatment of lung cancer with synchronous adrenal metastases: Adrenalectomy first.
abstract: BACKGROUND
  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.
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Mutua Terrassa, Tarrasa (Barcelona), España. Electronic address: fparanda@gmail.com.
authors.forename: Fernando
authors.initials: F
authors.lastname: Pardo Aranda
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Mutua Terrassa, Tarrasa (Barcelona), España.
authors.forename: Itziar
authors.initials: I
authors.lastname: Larrañaga Blanc
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Mutua Terrassa, Tarrasa (Barcelona), España.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Rivero Déniz
authors.affiliation: Servicio de Cirugía Torácica, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Trujillo
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Mutua Terrassa, Tarrasa (Barcelona), España.
authors.forename: Arantxa
authors.initials: A
authors.lastname: Rada Palomino
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Mutua Terrassa, Tarrasa (Barcelona), España.
authors.forename: Esteban
authors.initials: E
authors.lastname: García-Olivares
authors.affiliation: Servicio de Cirugía Torácica, Hospital Universitario Mutua Terrassa, Barcelona, España.
authors.forename: Ramón
authors.initials: R
authors.lastname: Rami Porta
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Mutua Terrassa, Tarrasa (Barcelona), España.
authors.forename: Enrique Veloso
authors.initials: EV
authors.lastname: Veloso
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000556:secondary* / Q000601:surgery*; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D000465:Algorithms; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D012189:Retrospective Studies
keywords: Adrenalectomy first; Adrenalectomía primero; Carcinoma pulmonar no microcítico; Metástasis suprarrenal sincrónica; Non-small cell lung cancer; Oligometastases; Oligometástasis; Synchronous adrenal metastases