Porte H L, Roumilhac D, Graziana J P, Eraldi L, Cordonier C, Puech P, Wurtz A J
Clinique Chirurgicale, Hôpital Calmette, Lille, France.
Ann Thorac Surg. 1998 Feb;65(2):331-5. doi: 10.1016/s0003-4975(97)01284-8.
Several case reports have shown that patients with truly solitary adrenal gland metastases can undergo resection with long-term survival.
We assessed consecutive patients with operable or operated non-small cell lung cancer in whom the presence of a unilateral solitary adrenal metastasis was confirmed histologically. Synchronous homolateral adrenal metastases were resected at the same time as the non-small cell lung carcinoma through a transphrenic approach. Synchronous contralateral or metachronous adrenal metastases were resected through an elective approach.
Of 598 patients with operable or operated non-small cell lung carcinoma, 11 had a unilateral solitary adrenal gland metastasis and underwent adrenalectomy with no additional mortality or morbidity. One patient died of late postoperative complications and 7 patients died of other distant metastases between 4 and 24 months after adrenalectomy. Two patients are still alive and free of recurrent disease and 1 patient is still alive with brain metastasis 66, 6, and 10 months, respectively, after adrenalectomy.
In the absence of selection criteria to identify the subgroup of patients who will benefit from surgical resection, we suggest the resection of synchronous lesions in patients without N2 involvement and the careful selection of patients with metachronous adrenal metastases according to the evolution of their disease.
多项病例报告显示，真正孤立性肾上腺转移瘤患者可接受手术切除并获得长期生存。
我们评估了连续的可手术或已接受手术的非小细胞肺癌患者，这些患者经组织学证实存在单侧孤立性肾上腺转移。同步同侧肾上腺转移瘤与非小细胞肺癌同时经经膈入路切除。同步对侧或异时性肾上腺转移瘤通过择期手术切除。
在598例可手术或已接受手术的非小细胞肺癌患者中，11例有单侧孤立性肾上腺转移并接受了肾上腺切除术，无额外的死亡率或发病率。1例患者死于术后晚期并发症，7例患者在肾上腺切除术后4至24个月死于其他远处转移。2例患者仍存活且无疾病复发，1例患者在肾上腺切除术后分别于66、6和10个月仍存活但有脑转移。
在缺乏识别可从手术切除中获益的患者亚组的选择标准的情况下，我们建议对无N2受累的患者切除同步病变，并根据疾病进展情况仔细选择异时性肾上腺转移患者。
