SURGICAL-TREATMENT OF ADRENAL METASTASIS FOLLOWING PULMONARY RESECTION FOR LUNG-CANCER - COMPARISON OF ADRENALECTOMY WITH PALLIATIVE THERAPY

Although adrenal metastases from lung cancer are frequently detected d uring the late clinical stage or at autopsy, they are rarely surgicall y treated following pulmonary resection for lung cancer. We detected a drenal lesions as initial clinical recurrence in 9 (1%) of 904 patient s who underwent pulmonary resection for lung cancer at our institute b etween 1980 and 1992. Adrenalectomy was performed in five who had deve loped unilateral adrenal metastasis. One underwent simultaneous operat ion for primary and metastatic lesions, and 4 underwent adrenal surger y following pulmonary resection. The adrenal tumor was removed via lap arotomy in three patients, and via posterolateral non laparotomic appr oach 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. Fol lowing adrenalectomy, all these patients were treated with adjuvant ch emotherapy or radiotherapy. Two patients have remained free of relapse for 40 and 26 months, respectively, after adrenal surgery, while thre e died of other distant metastases more than 9 months after adrenalect omy. In contrast, the four patients who received chemotherapy or radia tion therapy died less than 6 months after palliative therapy. Thus, w e consider that surgical treatment for adrenal metastases following pu lmonary resection for lung cancer is effective in selected cases. The indications for adrenalectomy are presented in comparison with those f or palliative therapy, and several difficulties in the surgical manage ment of adrenal metastases are discussed.