Insuficiencia respiratoria secundaria a un bocio endotorácico gigante / Respiratory failure due to a gigantic endothoracic goiter

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Cirugía de las metástasis en la glándula suprarrenal: resultados de una serie de 35 pacientes / Surgical treatment of adrenal gland metastases: results in a series of 35 patients

Introducción: Los objetivos de este estudio son comprobar los resultados de la suprarrenalectomía por metástasis y analizar los factores pronósticos que nos ayuden a predecir la supervivencia a largo plazo en este grupo de pacientes. Pacientes y métodos Estudio retrospectivo de 35 pacientes a los que se les realizó adrenalectomía por la presencia de metástasis, en el Hospital de Cruces desde 1996 hasta enero de 2010. El análisis de supervivencia se realizó por el método de Kaplan y Meier. Resultados El carcinoma de pulmón de células no pequeñas (CPCNP) fue el tumor primario más frecuente, con 18 casos. En 15 pacientes el diagnóstico de metástasis suprarrenal fue sincrónico con respecto al tumor primario y en 20 casos metacrónico. Solo 7 pacientes sobrevivieron sin enfermedad 12, 22, 26, 58, 60, 65 y 120 meses después de la adrenalectomía. La supervivencia libre de enfermedad a los 5 años fue, en la serie general, del 16% y en el subgrupo de CPCNP del 27%. Ninguno de los factores pronósticos evaluados (tamaño mayor de 4,5cm, estirpe celular, grado de diferenciación, quimioterapia, técnica quirúrgica, intervalo libre de enfermedad) tuvieron significación estadística en la supervivencia global, ni en la serie total, ni en el subgrupo de pacientes con CPCNP. Sin embargo, en pacientes de la serie general con recidiva tumoral, la diferencia de supervivencia entre metástasis metacrónicas y sincrónicas fue estadísticamente significativa (p=0,05), a favor de las primeras. Conclusiones La adrenalectomía mejora la supervivencia esperada, sobre todo, en pacientes con CPCNP. Los pacientes con metástasis metacrónica no presentan mayor tasa de supervivencia libre de enfermedad a los 5 años que aquellos con metástasis sincrónicas, pero sí tienen una supervivencia más larga, aunque con enfermedad. Cuando se produce una recidiva tumoral, esta suele ser precoz (AU)

Introduction: The objectives of this study are to present the results of adrenalectomies due to metastasis, and to analyse the prognostic factors that may help to predict long-term survivalin this patient group. Patients and methods: A retrospective study was conducted on 35 patients who underwent adrenalectomy for metastases in the Hospital de Cruces from 1996 to January 2010. The survival analysis was performed using the Kaplan and Meier method. Results: Non-small cell lung cancer (NSCLC) was the most frequent primary tumour, with18 cases. In 15 patients the diagnosis of adrenal metastasis was synchronous with the primary tumour, and in 20 cases it was metachronous. Only 7 patients survived with out disease for 12, 22, 26, 58, 60, 65 and 120 months after the adrenalectomy. The disease free survival at 5 years was 16% in the whole series, and 27% in the NSCLC sub-group. None of the prognostic factors evaluated (size greater than 4.5 cm, cell type, differentiation grade, chemotherapy, surgical technique, disease free interval) was statistically significant in the overall survival, either in the general series or in the sub-group of patients with NSCLC. However, in the general series with tumour recurrence, the difference in survival between metachronous and synchronous metastasis was statistically significant (P=.05), in favour of the former. Conclusions: Adrenalectomy improves the expected survival particularly in patients with NSCLC. Patients with metachronous metastases do not have a higher rate of disease free survival at 5 years than those with synchronous metastases, although they do have a longer survival with the disease. When there is tumour recurrence, it is usually early (AU)

[Surgical treatment of adrenal gland metastases: results in a series of 35 patients]. / Cirugía de las metástasis en la glándula suprarrenal: resultados de una serie de 35 pacientes.

INTRODUCTION: The objectives of this study are to present the results of adrenalectomies due to metastasis, and to analyse the prognostic factors that may help to predict long-term survival in this patient group. PATIENTS AND METHODS: A retrospective study was conducted on 35 patients who underwent adrenalectomy for metastases in the Hospital de Cruces from 1996 to January 2010. The survival analysis was performed using the Kaplan and Meier method. RESULTS: Non-small cell lung cancer (NSCLC) was the most frequent primary tumour, with 18 cases. In 15 patients the diagnosis of adrenal metastasis was synchronous with the primary tumour, and in 20 cases it was metachronous. Only 7 patients survived without disease for 12, 22, 26, 58, 60, 65 and 120 months after the adrenalectomy. The disease free survival at 5 years was 16% in the whole series, and 27% in the NSCLC sub-group. None of the prognostic factors evaluated (size greater than 4.5 cm, cell type, differentiation grade, chemotherapy, surgical technique, disease free interval) was statistically significant in the overall survival, either in the general series or in the sub-group of patients with NSCLC. However, in the general series with tumour recurrence, the difference in survival between metachronous and synchronous metastasis was statistically significant (P=.05), in favour of the former. CONCLUSIONS: Adrenalectomy improves the expected survival particularly in patients with NSCLC. Patients with metachronous metastases do not have a higher rate of disease free survival at 5 years than those with synchronous metastases, although they do have a longer survival with the disease. When there is tumour recurrence, it is usually early.