We have read with great interest the review from Sastry et al. [1]. Surgery is the main treatment protocol for non-metastatic lung cancer. Distant metastasis is suggested as stage 4 disease and surgery is not performed for these tumours. Surgery for solitary brain metastasis has been shown to prolong survival [2]. However, adrenalectomy in non-small-cell lung cancer is controversial. Several studies have been performed [3, 4] investigating the effect of adrenalectomy in non-small cell lung cancer. As a general rule of lung cancer treatment, we do not perform surgery for lung cancer patients who have distant metastasis. But we think that patients having only adrenal metastasis with a T1-2 tumour can be considered separately from this distant metastasis group and should be discussed within a multidisciplinary approach for adrenalectomy to improve survival. We report here our institutional results of adrenalectomy in non-small-cell lung cancer patients.
We operated on three synchronous isolated adrenal metastatic lung cancer patients [5]. All patients underwent lobectomy with lymph node dissection which revealed no mediastinal involvement. The first patient was operated on after neoadjuvant chemotherapy and the other two patients were submitted to surgery before subsequent adjuvant chemotherapy. One patient had bilateral adrenal metastasis; the other two had contralateral adrenal metastasis. The patients died 5 to 8 months after surgery.
We agree with the authors that patient selection is the key point in performing surgery. We applied surgery for contralateral and bilateral adrenal metastasis and our results are not convincing. As mentioned in the article from Sastry et al., ipsilateral adrenalectomy can be performed because improved survival has been shown [1]. We do not recommend adrenalectomy in patients with contralateral or bilateral adrenal metastasis.
We thank Sastry et al. for their study. We think that further studies are needed to constitute criteria for adrenalectomy in non-small-cell lung cancer patients.
Conflict of interest: none declared
References
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