Surgical resection of isolated adrenal metastases in patients with non-small cell lung cancer: a single-institution experience and review of the literature.

Background: In non-small cell lung cancer (NSCLC), the benefits of resection of solitary adrenal metastases for survival and the identification of patients most likely to benefit from adrenalectomy are unknown.

Methods: We retrospectively reviewed clinico-pathological factors and outcomes in 4 NSCLC patients treated with adrenalectomy at our centre. We reviewed the published literature with a focus on long-term survivors in order to formulate treatment recommendations.

Results: Local pathological staging showed stages IA-IIA. All had a performance status (PS) of 0. The median age was 56 years (range: 53-58 years). Adrenal metastases were detected by positron emission tomography-computed tomography (PET-CT) in 3 patients. Median time from lobectomy to occurrence of metachronous adrenal metastases was 12.3 months (11-14 months). The perioperative mortality was zero. All patients recurred systemically after adrenalectomy within 2-49 months. 3 patients died due to systemic progression 6-15 months after adrenalectomy. 1 patient is alive with pulmonary relapse 49 months after adrenalectomy.

Conclusions: Resection of solitary adrenal metastases in selected good-PS NSCLC patients with minimal local nodal involvement from the primary tumour is associated with low morbidity and may offer a chance for long-term disease-free survival in a small subset of patients. Careful pre-operative staging including PET-CT is warranted.