Tratamiento quirúrgico de la metástasis adrenal única en pacientes con cáncer de pulmón / Surgical treatment of solitary adrenal metastases in patients with lung cancer

Fundamento y objetivo: El cáncer de pulmón (CP) puede afectar a la glándula adrenal como metástasis única. El objetivo de este estudio es describir la experiencia en nuestro centro sobre pacientes intervenidos quirúrgicamente de metástasis suprarrenal de CP en los últimos 11 años. Pacientes y método: Se ha realizado un estudio retrospectivo descriptivo de los pacientes intervenidos quirúrgicamente de adrenalectomía por metástasis de CP. Resultados: Se incluyen 7 pacientes con una mediana de edad de 64 años. A 5 de ellos se les realizó una lobectomía y a 2 una neumonectomía con tratamiento adyuvante según protocolo. La metástasis suprarrenal única se presentó de forma sincrónica en 3 pacientes y metacrónica en 4, entre 10 y 39 meses (mediana de 25 meses). Dos pacientes siguen vivos y con buena calidad de vida. La supervivencia media de los pacientes fue de 41 meses (intervalo de confianza del 95% [IC 95%] 7-74), y la supervivencia mediana, de 20 meses (IC 95% 7-32). Conclusiones: Se puede afirmar que la ciru ía de la metástasis adrenal por CP aumenta la esperanza de vida en determinados pacientes según la bibliografía disponible (AU)

Background and objective: Lung cancer (LC) can metastasize the adrenal gland. The objective of this study is to describe our experience in patients undergoing surgery for solitary adrenal metastasis of lung cancer in the past 11 years. Patients and methods: It is a retrospective study of patients who underwent the surgical resection of the lung primary tumor and the adrenal metastases. Results: We included 7 patients with a median age of 64 years. Five patients underwent lobectomy, and 2, pneumonectomy with adjuvant therapy according to protocol. The single adrenal metastasis appeared synchronously in 3 patients and metachronously in 4, between 10 and 39 months (median 25 months). Two patients are alive and with good quality of life. The mean survival of patients was 41 months (95% confidence interval [95% CI] 7-74) and median survival was 20 months (95% CI 7-32). Conclusions: We conclude that surgery adrenal metastases from lung cancer increases life expectancy in selected patients according to the available literatura (AU)

A prospective study comparing three-port video-assisted thoracoscopy with the single-incision laparoscopic surgery (SILS) port and instruments for the video thoracoscopic approach: a pilot study.

BACKGROUND: Single-incision laparoscopic surgery (SILS) has proved its advantages in several procedures, mainly a shorter hospital stay, improved aesthetic results, and less postoperative pain. The authors have used this approach for several thoracic surgical procedures. METHODS: This prospective study compared 20 cases between standard three-port video-assisted thoracic surgery (VATS) and the single-incision approach using a standard abdominal SILS system. In both groups, postsurgical analgesia was provided with 15 ml of bupivacaine 0.5% at 3 h intervals via a paravertebral catheter. The hospital length of stay and chest drain duration (in hours) were recorded as well as postoperative pain using an analogic visual pain scale (AVPS). A telephone survey was conducted for all the outpatients. The Mann-Whitney U test was used for statistical analysis. RESULTS: This study of 20 procedures included 11 lung biopsies, 6 pneumothorax procedures, 2 mediastinic cystectomies, and 1 catamenial pneumothorax procedure. No statistically significant difference was reported in hospital length of stay or chest drain duration between the two groups. However, postoperative pain at 24 h was significantly less in the SILS group (AVPS, 4.40) than in the VATS group (AVPS, 6.20) (p = 0.035). The SILS group reported two minor surgical wound complications and one catamenial pneumothorax recurrence that did not require drainage. The VATS group reported one case of skin rash with no identifiable cause. CONCLUSIONS: The use of the SILS port in thoracic surgery results in less postoperative pain. This is related to the port's protective effect over the periostium and the intercostal nerve, relieving them of direct contact with surgical instruments. However, the findings showed a higher incidence of surgical wound complications with the SILS port, which can be attributed to increased pressure on the skin and soft tissues surrounding the port and to the fact that this same incision was used for chest drain placement, thus increasing the risk for complications.

[Surgical treatment of solitary adrenal metastases in patients with lung cancer]. / Tratamiento quirúrgico de la metástasis adrenal única en pacientes con cáncer de pulmón.

BACKGROUND AND OBJECTIVE: Lung cancer (LC) can metastasize the adrenal gland. The objective of this study is to describe our experience in patients undergoing surgery for solitary adrenal metastasis of lung cancer in the past 11 years. PATIENTS AND METHODS: It is a retrospective study of patients who underwent the surgical resection of the lung primary tumor and the adrenal metastases. RESULTS: We included 7 patients with a median age of 64 years. Five patients underwent lobectomy, and 2, pneumonectomy with adjuvant therapy according to protocol. The single adrenal metastasis appeared synchronously in 3 patients and metachronously in 4, between 10 and 39 months (median 25 months). Two patients are alive and with good quality of life. The mean survival of patients was 41 months (95% confidence interval [95% CI] 7-74) and median survival was 20 months (95% CI 7-32). CONCLUSIONS: We conclude that surgery adrenal metastases from lung cancer increases life expectancy in selected patients according to the available literature.