Original Paper Received: April 1, 2014 Accepted after revision: November 16, 2014 Published online: January 7, 2015
Dig Surg 2014;31:428–435 DOI: 10.1159/000370078
Resection of Metachronous Adrenal Metastasis after Liver Resection and Transplantation for Hepatocellular Carcinoma Tae-Yong Ha Shin Hwang Chul-Soo Ahn Ki-Hun Kim Young-Joo Lee Deok-Bog Moon Gi-Won Song Dong-Hwan Jung Gil-Chun Park Sung-Gyu Lee Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Key Words Hepatocellular carcinoma · Adrenal metastasis · Adrenalectomy · Liver resection · Liver transplantation
sions: Adrenalectomy is indicated in patients with isolated MAM-HCC. Comparisons with other locoregional treatment modalities and multicenter studies with additional patients are needed to validate the role of adrenalectomy. © 2015 S. Karger AG, Basel
Abstract Background: This study analyzed the patient survival outcomes following the resection of hepatocellular carcinoma (HCC) metachronous adrenal metastasis (MAM) in patients who had undergone liver resection or liver transplantation (LT). Methods: Clinical results were analyzed retrospectively in 26 patients with MAM-HCC who underwent adrenalectomy. Results: The mean interval between initial surgery and adrenalectomy was significantly shorter in the resection group than in the LT group (18.3 ± 14.4 vs. 42.6 ± 13.8 months, p < 0.001). Of 19 resected patients, four had adrenal metastases on the right side, 12 on the left side and three bilaterally, with a mean tumor diameter of 3.6 ± 1.5 cm. Ten of these patients underwent open surgery and nine underwent laparoscopic surgery; all patients experienced recurrences within 18 months and 20.3% survived 5 years after adrenalectomy. Of 7 patients who underwent LT, four had adrenal metastases on the right side and three on the left side, with a mean tumor diameter of 3.4 ± 1.8 cm. Six of these patients underwent open surgery and one underwent laparoscopic surgery. Five-year recurrence and patient survival rates after adrenalectomy were 28.6 and 85.7%, respectively. Conclu-
© 2015 S. Karger AG, Basel 0253–4886/15/0316–0428$39.50/0 E-Mail [email protected] www.karger.com/dsu
Introduction
Hepatocellular carcinoma (HCC) cells can spread throughout the body directly or through the lymphatic and vascular pathways, resulting in extrahepatic metastases at the time of initial diagnosis or at tumor recurrence. The most frequent sites of extrahepatic metastases in HCC patients are the lungs, lymph nodes, bones, and adrenal glands [1, 2], and they are usually concurrent with intrahepatic lesions, but can occur alone in the absence of intrahepatic recurrence. Surgical metastasectomy of the abdominal lymph nodes, adrenal glands, lungs, and peritoneum has shown encouraging survival results in highly selected patients [1–4]. Various therapeutic modalities, including nonsurgical treatments and surgical resection, have been used to treat patients with intrahepatic HCC recurrence. However, to our knowledge, there is no established strategy for the treatment of extrahepatic metastases, including metachronous adrenal metastasis (MAM). Patients with isolated exShin Hwang, MD, PhD Department of Surgery, Asan Medical Center University of Ulsan College of Medicine 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138–736 (Korea) E-Mail shwang @ amc.seoul.kr
trahepatic metastasis, preserved liver function, and adequate control of other recurrent tumors may benefit from the resection of the MAM-HCC [1]. The extrahepatic HCC metastases that occur after liver transplantation (LT) are usually more aggressive and have more complex biological features than HCC metastases after liver resection [5, 6]. This clinical study intended to analyze patient survival outcomes and further HCC recurrence patterns following adrenalectomy of MAM-HCC in patients who previously underwent liver resection or LT for primary HCC. Materials and Methods Patient Selection A review of our institutional database for HCC patients who had previously undergone liver resection or LT identified 26 patients with MAM-HCC who underwent adrenalectomy, including 19 of 4,236 patients (0.5%) who underwent liver resection for primary HCC from January 1996 to December 2011, and seven of 1,120 (0.6%) who underwent LT for pathologically confirmed HCC from January 2000 to December 2011. Other additional eight patients with adrenalectomy had received only prior nonsurgical treatments for primary HCC (incidence
Dig Surg 2014;31:428–435 DOI: 10.1159/000370078
Resection of Metachronous Adrenal Metastasis after Liver Resection and Transplantation for Hepatocellular Carcinoma Tae-Yong Ha Shin Hwang Chul-Soo Ahn Ki-Hun Kim Young-Joo Lee Deok-Bog Moon Gi-Won Song Dong-Hwan Jung Gil-Chun Park Sung-Gyu Lee Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Key Words Hepatocellular carcinoma · Adrenal metastasis · Adrenalectomy · Liver resection · Liver transplantation
sions: Adrenalectomy is indicated in patients with isolated MAM-HCC. Comparisons with other locoregional treatment modalities and multicenter studies with additional patients are needed to validate the role of adrenalectomy. © 2015 S. Karger AG, Basel
Abstract Background: This study analyzed the patient survival outcomes following the resection of hepatocellular carcinoma (HCC) metachronous adrenal metastasis (MAM) in patients who had undergone liver resection or liver transplantation (LT). Methods: Clinical results were analyzed retrospectively in 26 patients with MAM-HCC who underwent adrenalectomy. Results: The mean interval between initial surgery and adrenalectomy was significantly shorter in the resection group than in the LT group (18.3 ± 14.4 vs. 42.6 ± 13.8 months, p < 0.001). Of 19 resected patients, four had adrenal metastases on the right side, 12 on the left side and three bilaterally, with a mean tumor diameter of 3.6 ± 1.5 cm. Ten of these patients underwent open surgery and nine underwent laparoscopic surgery; all patients experienced recurrences within 18 months and 20.3% survived 5 years after adrenalectomy. Of 7 patients who underwent LT, four had adrenal metastases on the right side and three on the left side, with a mean tumor diameter of 3.4 ± 1.8 cm. Six of these patients underwent open surgery and one underwent laparoscopic surgery. Five-year recurrence and patient survival rates after adrenalectomy were 28.6 and 85.7%, respectively. Conclu-
© 2015 S. Karger AG, Basel 0253–4886/15/0316–0428$39.50/0 E-Mail [email protected] www.karger.com/dsu
Introduction
Hepatocellular carcinoma (HCC) cells can spread throughout the body directly or through the lymphatic and vascular pathways, resulting in extrahepatic metastases at the time of initial diagnosis or at tumor recurrence. The most frequent sites of extrahepatic metastases in HCC patients are the lungs, lymph nodes, bones, and adrenal glands [1, 2], and they are usually concurrent with intrahepatic lesions, but can occur alone in the absence of intrahepatic recurrence. Surgical metastasectomy of the abdominal lymph nodes, adrenal glands, lungs, and peritoneum has shown encouraging survival results in highly selected patients [1–4]. Various therapeutic modalities, including nonsurgical treatments and surgical resection, have been used to treat patients with intrahepatic HCC recurrence. However, to our knowledge, there is no established strategy for the treatment of extrahepatic metastases, including metachronous adrenal metastasis (MAM). Patients with isolated exShin Hwang, MD, PhD Department of Surgery, Asan Medical Center University of Ulsan College of Medicine 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138–736 (Korea) E-Mail shwang @ amc.seoul.kr
trahepatic metastasis, preserved liver function, and adequate control of other recurrent tumors may benefit from the resection of the MAM-HCC [1]. The extrahepatic HCC metastases that occur after liver transplantation (LT) are usually more aggressive and have more complex biological features than HCC metastases after liver resection [5, 6]. This clinical study intended to analyze patient survival outcomes and further HCC recurrence patterns following adrenalectomy of MAM-HCC in patients who previously underwent liver resection or LT for primary HCC. Materials and Methods Patient Selection A review of our institutional database for HCC patients who had previously undergone liver resection or LT identified 26 patients with MAM-HCC who underwent adrenalectomy, including 19 of 4,236 patients (0.5%) who underwent liver resection for primary HCC from January 1996 to December 2011, and seven of 1,120 (0.6%) who underwent LT for pathologically confirmed HCC from January 2000 to December 2011. Other additional eight patients with adrenalectomy had received only prior nonsurgical treatments for primary HCC (incidence
