Role of Mediastinal Nodal Status in the Selection of Patients with Non-small Cell Lung Cancer and Isolated Adrenal Metastases for Radical Surgical Treatment

Abstract

The treatment of patients with isolated adrenal metastases remains controversial. Metastases from NSCLC suggest that these patients could have improved survival. The role of N2 status as independent predictor of poor survival is still unclear and under discussion. The aim of this study was to evaluate the role of mediastinal nodal status in patients with isolated adrenal metastases form Non Small Cell Lung Cancer (NSCLC) treated with surgery. A total of eight patients with NSCLC and isolated adrenal lesions were operated on for a period of ten years. They were divided into two groups depending on the morphology of the adrenal lesion. Group I includes 4 patients with adrenal metastases which underwent lobectomy and Retroperitoneal Endoscopic Adrenalectomy (REA). The loco regional stage was pI in 3 patients and pIIA in one. The mean size of the metastases was 24.5 mm, without capsular invasion and all of them were metachronous. The other four patients were proven to be with adenomas of the adrenal gland. All of the patients underwent lobectomy with locoregional stage pIIIA (3) and pIIA. One stage operation was performed in two cases – left lower lobectomy and adrenalectomy via frenotomy. REA was performed in two of the patients. No major postoperative complications were observed. The median survival is 34.75 months in Group I and 18.6 months in Group II. Two of the patients from Group I are still alive at the end of the study – 57 and 34 months after the initial surgery. The mediastinal nodal status is significant and independent prognostic factor for survival in surgical patients with NSCLC and isolated adrenal metastasis.