Higashiyama M, Doi O, Kodama K, Yokouchi H, Imaoka S, Koyama H
Department of Thoracic Surgery, Center for Adult Diseases, Osaka, Japan.
Int Surg. 1994 Apr-Jun;79(2):124-9.
Although adrenal metastases from lung cancer are frequently detected during the late clinical stage or at autopsy, they are rarely surgically treated following pulmonary resection for lung cancer. We detected adrenal lesions as initial clinical recurrence in 9 (1%) of 904 patients who underwent pulmonary resection for lung cancer at our institute between 1980 and 1992. Adrenalectomy was performed in five who had developed unilateral adrenal metastasis. One underwent simultaneous operation for primary and metastatic lesions, and 4 underwent adrenal surgery following pulmonary resection. The adrenal tumor was removed via laparotomy in three patients, and via posterolateral non laparotomic approach in two. Co-metastatic lesions which were detected incidentally at operation included intestinal metastasis in two patients and regional lymph node metastasis in two; these were simultaneously resected. Following adrenalectomy, all these patients were treated with adjuvant chemotherapy or radiotherapy. Two patients have remained free of relapse for 40 and 26 months, respectively, after adrenal surgery, while three died of other distant metastases more than 9 months after adrenalectomy. In contrast, the four patients who received chemotherapy or radiation therapy died less than 6 months after palliative therapy. Thus, we consider that surgical treatment for adrenal metastases following pulmonary resection for lung cancer is effective in selected cases. The indications for adrenalectomy are presented in comparison with those for palliative therapy, and several difficulties in the surgical management of adrenal metastases are discussed.
尽管肺癌肾上腺转移在临床晚期或尸检时经常被发现，但在肺癌肺切除术后很少进行手术治疗。1980年至1992年间，在我院接受肺癌肺切除的904例患者中，有9例（1%）最初临床复发时检测到肾上腺病变。5例发生单侧肾上腺转移的患者接受了肾上腺切除术。1例同时进行了原发灶和转移灶手术，4例在肺切除术后接受了肾上腺手术。3例患者通过剖腹手术切除肾上腺肿瘤，2例通过后外侧非剖腹手术途径切除。术中偶然发现的合并转移灶包括2例肠转移和2例区域淋巴结转移；这些均同时进行了切除。肾上腺切除术后，所有这些患者均接受了辅助化疗或放疗。2例患者肾上腺手术后分别无复发40个月和26个月，而3例在肾上腺切除术后9个月以上死于其他远处转移。相比之下，接受化疗或放疗的4例患者在姑息治疗后不到6个月死亡。因此，我们认为肺癌肺切除术后肾上腺转移的手术治疗在某些病例中是有效的。本文将肾上腺切除术的指征与姑息治疗的指征进行了比较，并讨论了肾上腺转移手术治疗中的几个难点。
