Table 13.

Best articles and their details.

Author info	Patient group	Outcomes	Key results	Comments
Raz et al. [417](USA) (retrospective cohort study (level 4, good))	37 patients identified with isolated adrenal metastases from NSCLC	5-year survival	34% in the adrenalectomy group versus 0% in the non-operative group (P=0.002)	The selection process for operative and non-operative management was inconsistent
	20 underwent surgical resection		83% for ipsilateral tumors versus 0% for contralateral tumors (P=0.003)	Adrenalectomy patients were on average 10 years younger
	17 underwent non-operative management		67% in case of lower lobe NSCLC versus 27% in cases of upper lobe tumors (P=0.29)	50% of patients in the adrenalectomy group (and 70% in the non-operated group) had N2 or T4 diseases; therefore, the adrenal metastasis was not truly isolated
	Maximum follow-up period of 16 years		27% synchronous metastasis versus 41% metachronous metastases (P=0.81)	Significant variability in treatment with chemotherapy and radiotherapy
			52% with N0 or N1 disease versus 0% with N2 diseases (P=0.008)
Luketich and Burt [418] (USA) (retrospective cohort study (level 4, good))	14 patients with isolated synchronous adrenal metastasis from NSCLC	Medium survival	Medium survival of 8.5 months in the chemotherapy alone group versus 31 months in the chemotherapy + surgery group	Small study, but no significant differences were seen in preoperative characteristics, tumor size, or cell type to otherwise explain the improved survival
	8 patients had neoadjuvant chemotherapy followed by concomitant lung resection and adrenalectomy		In the surgically resected group, the 3-year actuarial survival was 38%
	6 patients had only 3 cycles of chemotherapy (mitomycin, cisplatin, and vinblastine)		Longest survivor at end of follow-up was 61 months	The authors recommend that surgery should be advocated after ensuring that curative resection of the lung primary can be achieved
	5-year follow-up
Higashiyama et al. [416] (retrospective cohort study (level 4, good))	9 patients with isolated adrenal metastases from surgically resected lung cancer (4 non-curative and 5 curative)	Survival	Adrenalectomy group: 2/5 alive at 24 and 40 months, respectively, and 3/5 died at 9, 17, and 20 months, respectively	All patients in the palliative group had a disease-free interval of 7 months. This selection bias may explain some of the observed difference in survival in addition to the influence of treatment strategy.
	5 treated with adrenalectomy followed by adjuvant chemo or radiotherapy
	4 treated with palliative chemo or radiotherapy		Palliative group: all died within 6 months	The authors concluded that short FDIs are probably due to lymphatic spread and probably signify a more aggressive tumor
	Maximum follow-up of 40 months