Adrenalectomy for metastases from hepatocellular carcinoma - a single center experience.
BACKGROUND
Adrenal metastases (AM) from hepatocellular carcinoma (HCC) are rarely seen in clinical practice. The treatment is not standardized, the indications and efficacy of different therapeutic approaches being still controversial.


METHODS
Between January 1995 and December 2005, 174 patients underwent liver resection for HCC in our center. AM were detected in four patients (2.3%): three of them had HCC and synchronous AM, and the remaining one developed AM 10 months after liver resection. All the patients with AM were treated by adrenalectomy (simultaneously with liver resection in synchronous metastases), followed by systemic chemotherapy. Non-resectable multifocal liver recurrences occurred in two patients, one of them having also a contralateral adrenal metastasis; these two patients are presently alive 26 and 43 months after adrenalectomy, respectively. Another patient died by liver recurrence 27 months postoperatively. The fourth patient is disease-free at 17 months after the initial operation.


CONCLUSIONS
Adrenalectomy for AM from HCC should be performed whenever the primary tumor is well therapeutically controlled and the patient has a good performance status. Adrenalectomy offers the chance of more than 2 years survival in many patients. However, once AM are detected, the prognosis remains poor.
Popescu
Irinel
I
Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Sos. Fundeni 258, sector 2, 022328 Bucharest, Romania. irinel.popescu@icfundeni.ro
Alexandrescu
Sorin
S
Ciurea
Silviu
S
Brasoveanu
Vlad
V
Hrehoret
Doina
D
Gangone
Eliza
E
Boros
Mirela
M
Herlea
Vlad
V
Croitoru
Adina
A
D000310:Adrenal Gland Neoplasms / Q000556:secondary / Q000601:surgery*; D000315:Adrenalectomy; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000556:secondary / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged