patients with adrenal metastases from bronchogenic carcinoma are considered incurable and any surgical treatment is usually excluded . a review of the few cases of adrenalectomy for metastases from lung cancer that have been reported in the literature shows that good results can be achieved in selected patients . the current indications for laparoscopic adrenalectomy can include the removal of small metastatic adrenal lesions in selected cases . they can be detected either during routine staging workup of the disease or during follow - up after resection of the primary tumor . in both cases any surgical intervention is usually excluded , even if the lung cancer is well - controlled ( i.e. , stage t1 - 2 no ) . however , a small number of cases of adrenalectomy for metastases from non - small cell lung carcinoma have been reported in the literature with good results . we describe the first reported case of laparoscopic resection of a solitary adrenal metastasis from lung cancer . a 69-year - old man , heavy smoker , had undergone a right lower lobectomy and mediastinal lymph node resection for adenocarcinoma of the lung of moderate differentiation , with negative for metastases lymph nodes ( stage : t2 no mo ) . eight months after the operation , during followup , computed tomography ( ct ) revealed a solitary mass in his right adrenal gland ( figure 1 ) . the findings from the physical examination were normal and his hemoglobin level was 13.8 g / dl . we used the transperitoneal laparoscopic approach as described before . with no particular difficulty , after ligation of the right adrenal vein , the tumor was resected in total . the resected specimen weighed 80 g and had a size of 7  5.5  5 cm . about one - third of patients dying of lung cancer have adrenal metastases at autopsy . preoperative staging with ct scan will reveal adrenal lesions in 7.5% of patients with non - small cell lung carcinoma . a unilateral adrenal mass can be detected with ct scan in 4.1% of cases with otherwise operable lung cancer . however , a needle biopsy is necessary in order to confirm the diagnosis of metastatic disease , since about two - thirds of the adrenal masses can be benign adenomas . although patients with metastases from lung cancer are not candidates for surgery , a few cases of adrenalectomy for metastasis from non - small cell lung carcinoma have been reported in the literature . among 18 cases that have been recorded through 1995 , seven patients ( 39% ) were alive after 3 to 14 years ( median : 5 years ) of follow - up . in 1996 , in a retrospective review of 14 patients with non - small cell lung carcinoma and a solitary adrenal metastasis who were managed with chemotherapy alone ( n=6 ) or with chemotherapy followed by adrenalectomy ( n=8 ) , luketich et al . reported a median survival of 8.5 months in the first group compared with 31 months in the second group ( p=0.03 ) . in another study of 52 patients who underwent adrenalectomy for metastases from various primary tumor sites ( including 11 cases with metastases from lung cancer ) , a significantly improved survival rate in patients with adrenal metastases due to adenocarcinoma compared with that in other histological types was recorded as well . in spite of the small number of patients , all authors agree that resection of adrenal metastases in selected patients could be beneficial . prerequisites for adrenalectomy that have been suggested are complete control of the primary tumor , no evidence of other metastases , and good performance status . we elected to proceed with laparoscopy in order to evaluate the peritoneal cavity for other metastases , assess local infiltration that would make an adrenalectomy impossible and above all , if the previous two evaluations were negative , to offer the patient the advantages of laparoscopic adrenalectomy . having succeeded to remove the metastatic adrenal tumor laparoscopically , without rupturing the capsule , with minimal hospital stay and minimal postoperative pain and disability , we suggest that the cur - rent indications for laparoscopic adrenalectomy can include the removal of small metastatic adrenal lesions in selected cases .
background and objectives : patients with adrenal metastases from bronchogenic carcinoma are considered incurable and any surgical treatment is usually excluded . 
 a review of the few cases of adrenalectomy for metastases from lung cancer that have been reported in the literature shows that good results can be achieved in selected patients . 
 we propose a laparoscopic approach to perform the adrenalectomy in these patients.methods:a right laparoscopic adrenalectomy for metastasis from lung adenocarcinoma was performed . 
 the right adrenal was resected using the anterior transperitoneal laparoscopic approach.results:the tumor was resected in total . 
 the operating time was two hours . 
 one year after surgery the patient remains well.conclusions:the current indications for laparoscopic adrenalectomy can include the removal of small metastatic adrenal lesions in selected cases .