Management of adrenal metastasis from hepatocellular carcinoma.
OBJECTIVE
Although the adrenal gland is a common site of extrahepatic metastasis from hepatocellular carcinoma (HCC), there are no definitive guidelines for the treatment of adrenal metastasis. This study examines the effectiveness of various treatments for this disease.


METHODS
We retrospectively analyzed 20 patients treated for adrenal metastasis of HCC by adrenalectomy ( n = 13), transarterial chemoembolization (TACE), or percutaneous ethanol injection therapy (PEIT) ( n = 7).


RESULTS
There were no significant differences in cumulative survival rates between patients given adrenalectomy and those given TACE or PEIT, either after completing treatment for primary HCC or after the first treatment for adrenal metastasis. Six of seven patients with tumor thrombi in the inferior vena cava (IVC) from adrenal metastasis underwent adrenalectomy combined with intracaval thrombectomy, five of whom survived for more than 1 year after surgery, and two of whom are still alive without any recurrence more than 3 years after surgery. PEIT showed good results for small adrenal metastasis.


CONCLUSIONS
These findings suggest that therapeutic modalities should be chosen according to the clinical features of each individual, including the size of the metastatic tumor, whether there is invasion into the IVC, the function of the remaining liver, and the existence of intra- and/or nonadrenal extrahepatic lesions. Furthermore, intracaval tumor thrombectomy could be indicated for patients with IVC thrombus if they are suitable candidates for surgery.
Momoi
Hirohito
H
Department of Gastroenterological Surgery, Kyoto University Graduate School of Medicine, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
Shimahara
Yasuyuki
Y
Terajima
Hiroaki
H
Iimuro
Yuji
Y
Yamamoto
Naritaka
N
Yamamoto
Yuzo
Y
Ikai
Iwao
I
Yamaoka
Yoshio
Y
D000310:Adrenal Gland Neoplasms / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000473:pathology
D000431:Ethanol