Surg Today Jpn J Surg (1999) 29:1277–1279 Laparoscopic Adrenalectomy for Solitary Metachronous Adrenal Metastasis from Lung Cancer: Report of a Case Yoshihiko Tsuji, Masao Yasuhuku, Tomoki Haryu, Yoshihisa Watanabe, Keiji Ataka, and Masayoshi Okada Department of Surgery, Division II, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan Abstract: We report herein the case of a 69-year-old man who underwent laparoscopic adrenalectomy for a solitary adrenal metastasis 10 months after a left lower lobectomy for T2N1M0 lung cancer. A 30  20 mm tumor was found in the left adrenal gland, and dissected using an ultrasonically activated scalpel. Histological examination revealed metastatic squamous cell carcinoma. The patient recovered uneventfully and his condition is now stable 18 months after the second operation, with no evidence of local recurrence or metastatic disease. Although laparoscopic resection for malignant adrenal tumors is still controversial, we consider that laparoscopic adrenalectomy may be an optional treatment for metastatic adrenal tumors, provided the tumor is solitary, small in size, and well-localized. To our knowledge, only 14 cases of laparoscopic adrenalectomy for malignant tumors have been reported to date; however, this is the first case of successful laparoscopic adrenalectomy for a metastasis from lung cancer. Key Words: laparoscopic adrenalectomy, adrenal metastasis, lung cancer Introduction Despite the fact that adrenal metastasis from lung cancer is often encountered in autopsy series, the incidence of solitary adrenal metastasis in patients with potentially curative lung resection is low. 1,2 This report describes the case of a patient who underwent laparo- scopic resection of a metachronous adrental metastasis from lung cancer. To the best of our knowledge, this is the first case of successful laparoscopic adrenalectomy for metastasis from squamous cell carcinoma of the lung. Reprint requests to: Y. Tsuji (Received for publication on Nov. 26, 1998; accepted on May 27, 1999) Case Report A 69-year-old man was admitted to our hospital with a chief complaint of hemosputum. Chest X-ray and computed tomogram (CT) demonstrated a mass lesion, 30 mm in size, in the left lower lobe of the lung. Bronchoscopy revealed a tumor on the left basal bronchus, and squamous cell carcinoma was detected by a biopsy specimen. No metastatic lesions were revealed by abdominal CT, cerebral CT, or bone scintigram. In November 1996, the patient underwent an uncomp- licated left lower lobectomy with mediastinal and hilar lymph node dissection. Pathological examination of the lobectomy specimen confirmed T2 squamous cell carcinoma with N1 lymph node metastasis. The surgical margin was free of disease, being stage T2N1M0. The patient had an uneventful postoperative course, and was discharged 20 days after his operation. The patient was given follow-up treatment with oral tegafur-uracil, 300 mg/day (UFT: Taiho Pharmaceu- tical, Osaka, Japan), and remained well until July 1997, 8 months later, when his serum carcinoembryonic antigen (CEA) became elevated to 23.8 ng/ml, and an abdominal CT showed an asymptomatic left adrenal mass, 30  20 mm in size (Fig. 1). The mass was well localized, and no para-aortic lymph node metastasis or direct invasion to the surrounding tissues was detected. There was no local recurrence of the tumor on chest X-ray or CT, and no distant metastasis was found by abdominal CT, cerebral CT, and bone scintigram. Metabolic studies, conducted by 24-h urine collections for 17-ketosteroids, 17-hydroxycorticoids, adrenaline, noradrenaline, dopamine, and serum cortisol level revealed normal results. In September 1997, the patient underwent a laparoscopic left adrenalectomy. No ascites, tumor dis- semination, or liver metastasis was found by laparo- scopic inspection. The Gerota’s fascia was incised over the left kidney, exposing the left renal and adrenal