Management of adrenal metastasis of hepatocellular carcinoma by asynchronous resection of bilateral adrenal glands

Citation
T. Morimoto et al., Management of adrenal metastasis of hepatocellular carcinoma by asynchronous resection of bilateral adrenal glands, J GASTRO, 34(1), 1999, pp. 132-137
Citations number
10
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Gastroenerology and Hepatology
Journal title
JOURNAL OF GASTROENTEROLOGY
ISSN journal
0944-1174 → ACNP
Volume
34
Issue
1
Year of publication
1999
Pages
132 - 137
Database
ISI
SICI code
0944-1174(199902)34:1<132:MOAMOH>2.0.ZU;2-M
Abstract
We report on a 65-year-old man who received asynchronous bilateral adrenale ctomy for adrenal metastasis of hepatocellular carcinoma. Fifteen months af ter curative resection of right hepatic lobe for hepatocellular carcinoma, a metastatic lesion of the left adrenal gland was detected and left adrenal ectomy was performed. Ten months after the second operation, a metastatic l esion in the right adrenal gland, associated with tumor thrombus in the inf erior vena cava. was revealed. Transcatheter arterial embolization of the a rteries feeding the metastatic tumor was performed, but its effects were in complete. As there was the tumor thrombus in the inferior vena cava and no other intrahepatic recurrence or extrahepatic metastasis was found, resecti on of the right adrenal gland with tumor thrombus, without the employment o f veno-venous bypass. was performed, followed by postoperative hormonal sup plementation. Changes in the patient's alpha-fetoprotein level were clinica lly useful for the detection of the metastatic lesions and the evaluation o f therapeutic effects. Metastasis to adrenal gland from hepatocellular carc inoma should be actively managed, and the appropriate surgical treatment se lected, if intrahepatic recurrence and/or other extrahepatic metastasis are controlled. To achieve higher curability and better outcome in patients wi th bilateral adrenal metastasis of hepatocellular carcinoma, bilateral tota l adrenalectomy is indicated, accompanied by effective postoperative hormon al supplementation.