Pardo Aranda Fernando, Larrañaga Blanc Itziar, Rivero Déniz Joaquín, Trujillo Juan Carlos, Rada Palomino Arantxa, García-Olivares Esteban, Rami Porta Ramón, Veloso Enrique Veloso
Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Mutua Terrassa, Tarrasa (Barcelona), España.
Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Mutua Terrassa, Tarrasa (Barcelona), España.
Cir Esp. 2017 Feb;95(2):97-101. doi: 10.1016/j.ciresp.2017.01.003. Epub 2017 Feb 21.
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.
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.
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.
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.
本研究的目的是介绍我们采用一种逆向方法治疗的肺癌合并同步肾上腺转移患者：先进行肾上腺切除术，然后再进行肺切除术。
共进行了108例腹腔镜肾上腺切除术，我们分析了连续10例经手术序贯治疗的孤立性肺同步肾上腺转移患者。所有患者均接受分期纵隔镜检查，淋巴结阳性患者首先接受化疗。我们分析了：术后发病率、住院时间、两次手术之间的时间、无进展生存期和总生存期。采用Kaplan-Meier方法进行生存分析。
平均年龄：56.8（41 - 73）岁。其中，8例患者通过腹腔镜手术。转移灶平均大小：5.9（3 - 10）厘米。两次手术之间的天数为28（12 - 35）天。肾上腺切除术后无并发症。住院时间为4.3（3 - 5）天。2年无病生存率为60%，5年总生存率为30%，中位生存期为41.5（0 - 98）个月。
肾上腺切除术不会导致明显的并发症，可安全进行且不延迟肺手术，只要我们确保肾上腺完全切除，就能成功对原发性肺肿瘤进行手术。多学科肿瘤委员会必须对所有病例进行个体化评估，并在所有可切除原发性肿瘤和可切除肾上腺转移的患者中考虑这种治疗方法。
