title: Surgical management for adrenal gland metastasis of hepatocellular carcinoma.
abstract: OBJECTIVE
  Although the adrenal gland is one of the common sites for metastasis from hepatocellular carcinoma, the significance of adrenalectomy for treatment of metastatic hepatocellular carcinoma still remains unclear.
  
  
  METHODS
  Analysis of 4 patients with adrenal metastasis from among 390 patients with hepatocellular carcinoma admitted to our department between October 1994 and December 1997, and a review of 79 cases reported between 1984 and 1997, were performed.
  
  
  RESULTS
  Four patients with adrenal metastasis, right in 2 and left in 2, underwent surgical treatment. Three of the patients developed tumor thrombi in the renal vein or inferior vena cava. Diagnosis of adrenal metastasis was made by ultrasonography or computed tomography scan, following an increase in serum tumor markers. Adrenalectomy with removal of the venous tumor thrombi was performed successfully. Three patients died of recurrence within 1 year, and one patient died due to other causes showing no recurrence at autopsy. The literature review revealed the left-sided metastases were significantly larger than the right-sided ones (p < 0.01). There was no significant difference in the survival periods between left and right metastasis, or between patients who underwent adrenalectomy and those treated by other means (p > 0.05).
  
  
  CONCLUSIONS
  The rationality of surgical treatment for adrenal metastasis from hepatocellular carcinoma still remains controversial. However, we believe that adrenalectomy would be a safe procedure and increases the chance of survival for patients.
authors.affiliation: Second Department of Surgery, Faculty of Medicine, University of Tokyo, Japan. SAKAMOTO-2SU@h.u-tokyo.ac.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: K
authors.initials: K
authors.lastname: Kubota
authors.forename: M
authors.initials: M
authors.lastname: Mori
authors.forename: K
authors.initials: K
authors.lastname: Inoue
authors.forename: H
authors.initials: H
authors.lastname: Abe
authors.forename: Y
authors.initials: Y
authors.lastname: Harihara
authors.forename: Y
authors.initials: Y
authors.lastname: Bandai
authors.forename: M
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D000315:Adrenalectomy; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D002423:Cause of Death; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009360:Neoplastic Cells, Circulating; D015996:Survival Rate