Adrenalectomy for clinically isolated metastasis from colorectal carcinoma: report of eight cases.
OBJECTIVE
Metastasis to the adrenal glands is a relatively frequent finding at autopsy. Adrenal metastasis of colorectal carcinoma is rare (14 percent). Isolated adrenal metastasis is even rarer, and presents a therapeutic dilemma.


METHODS
Between 1997 and 2006, eight patients (5 men; mean age, 62 years) underwent adrenalectomy for metastasis of colorectal carcinoma. The tumors were Stage D in four cases, Stage B in two cases, and Stage C in the remaining two. Adjuvant chemotherapy was instituted.


RESULTS
All patients were asymptomatic, and adrenal metastasis was suspected from an elevated serum level of carcinoembryogenic antigen or discovered by computed tomography. Adrenal metastases were metachronous in seven patients, with median disease-free interval of 3.75 years. At the time of follow-up, one patient remained alive and free of disease 12 months after adrenalectomy, one patient was lost to follow-up after 22 months, and 6 patients have died from malignancy. The mean survival for the patients who died was 32 months.


CONCLUSIONS
The rarity of isolated adrenal metastasis of colorectal carcinoma makes a randomized, prospective trial comparing surgery vs. nonsurgical management highly unlikely. Our results provide further support for surgical resection of solitary adrenal metastasis, which may translate into survival benefit.
Mourra
Najat
N
Department of Pathology, Hôpital St-Antoine, Paris, France. najat.mourra@sat.ap-hop-paris.fr
Hoeffel
Christine
C
Duvillard
Pierre
P
Guettier
Catherine
C
Flejou
Jean-François
JF
Tiret
Emmanuel
E
D000310:Adrenal Gland Neoplasms / Q000556:secondary* / Q000601:surgery*; D000315:Adrenalectomy; D000368:Aged; D002277:Carcinoma / Q000556:secondary* / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome