Surgical treatment in patients with NSCLC and isolated distant metastases

Aim: To present the theoretical basis and own experience in surgical treatment of patients with NSCLC and isolated adrenal metastases (IAM) . Materials and methods: Literature review is presented: indications and methods for operative treatment, long term results and prognostic factors. The two institutional experience includes 12 patients (mean age 58.6 years) which underwent adrenalectomy due to IAM from radically resected NSCLC. The patients were precisely staged preoperatively. Only one patient had positive mediastinal nodal status (single lymph node from group 5). Seven of the metastases are synchronous, and five metachronous, 8 are ipsilateral and four contralateral. One patient underwent one stage operation - left lower lobectomy, phrenotomy and adrenalectomy. The rest 10 patients were operated in two stages- the lung resection was done first in 10 patients, followed by retroperitoneal endoscopic adrenalectomy (REA) (6), adrenalectomy via subcostal laparotomy (3) and endoscopic intra-peritoneal adrenalectomy (1). In 1 patient REA was first, followed by right lower lobectomy. Left lower lobectomy was followed by left REA and poly-segmental right lung resection due to metachronous metastases in 1 patient. All patients are followed until their death or the end of the study (mean 51 months). The survival is calculated with Kaplan-Meier method. Results: No postoperative complications were observed, except one late postpneumonectomy empyema, successfully treated with VATS. The mean disease free interval I 18.4 months, and surgical treatment of patients with IAM from NSCLC is possible in selected cases in early locoregional stage. The main prognostic factors are the long disease free interval and the absence of mediastinal lymph node involvement.