Adrenal Metastasis of Hepatocellular Carcinoma in Patients following Liver Resection or Liver Transplantation: Experience from a Tertiary Referral Center

Abstract

Introduction Adrenal metastasis of hepatocellular carcinoma (HCC) is a rare entity and can be treated by resection, local ablative therapy, or systemic therapy. Unfortunately, data about treatment outcome, especially in liver transplant recipients, are rare. Patients and Methods From 2005 to 2015, 990 liver resections and 303 liver transplantations because of HCC were performed at our clinic. We retrospectively analyzed treatment outcome of the patients with metachronous adrenal metastasis of HCC, who received either resection, local ablation, or surveillance only. Results 10 patients were identified (0.8%). 7 patients received liver transplantation for primary HCC therapy, 3 liver resection, and 1 a local ablative therapy. 8 patients underwent adrenalectomy (one via retroperitoneoscopy), one was treated with local ablation, and one had surveillance only. Seven out of eight patients had no surgical complications and one experienced a pancreatic fistula, treated conservatively. 37.5% of the resected patients had recurrence 1 year after adrenalectomy and 75% after 2 years. The mean survival time after primary diagnosis of HCC was 96.6±22.4 months. After adrenalectomy, the mean survival time was 112.4±25.2 months. The mean time until tumor recurrence was 13.2±3.8 in the total cohort and 15.8±3.8 months in patients after adrenalectomy. The estimated overall survival after adrenalectomy was 77.2±17.4 months. Conclusion Metachronous adrenal metastasis occured in less than 1% of HCC patients. Adrenalectomy is a safe procedure and leads to acceptable survival rates even after liver transplantion. Therefore, it should be performed whenever the primary tumor is well controlled and the patient is in adequate physical condition.

Survival After Adrenalectomy for Metastatic Hepatocellular Carcinoma: A 25‐year Institutional Experience

“…Adrenal metastasis originating from HCC is rare. In a cohort of 11770 HCC patients treated at Yonsei University Medical Center, Seoul, Korea, Park et al observed 45 individuals with adrenal metastasis (0.4%), whereas Teegen et al reported ten patients with HCC adrenal metastasis in a cohort of 1293 patients treated with either liver resection (990 patients) or liver transplantation (303 patients) for underlying HCC at Charité University Medical Center, Berlin, Germany (0.8%) [ 11 , 15 ]. In this sense, the seemingly small number of cases in the current cohort undergoing adrenalectomy for HCC adrenal metastasis (16 patients) represents a noteworthy collective of 25 years of surgical practice in our clinic.…”

“…In the present cohort, synchronous adrenal HCC metastasis was observed in three cases (all three cases received different primary HCC treatment: systemic treatment with sorafenib, local ablative treatment or liver resection with simultaneous adrenalectomy). The literature described that liver transplantation as a primary therapy for HCC was associated with later onset of metastasis to the adrenal gland, when compared to different primary treatment concepts [ 15 , 25 ]. Also, in the present cohort, the onset of adrenal metastasis was later, if the overall treatment concept included liver transplantation (median 24 months vs. 13 months).…”

“…Park et al [ 11 ] observed a superior post-resection survival after adrenalectomy of 21 months. In comparison, Teegen et al [ 15 ] reported a median post-resection survival of 69 months after adrenalectomy for metastatic HCC. Whereas the median overall survival in the present cohort of patients who underwent surgery for HCC adrenal metastasis was 35 months, Teegen et al [ 15 ] observed a median overall survival of 110 months.…”

“…The most common sites of extrahepatic HCC metastases are lung (39.5-53.1% of HCC patients with extrahepatic manifestation), lymph nodes (29.6-34.2%) and bone (25.4-43.2%) [10,[13][14][15][16][17][18][19]. In comparison, metastases to the adrenal glands are relatively infrequent (8.0-19.1% of HCC patients with extrahepatic manifestation) [12][13][14][15][16]. Due to the small number of cases, most studies addressing HCC with adrenal metastasis-even if performed by specialized centers for liver disease-refer to restricted patient cohorts ( Table 1).…”

Seminal vesicle metastasis after liver transplantation for hepatocellular carcinoma

“…This patient had metastases that occurred in liver, adrenal gland, intestinal wall, and seminal vesicle. Furthermore, extrahepatic metastases especially after LT are more aggressive compared to those occurring in patients without LT. [4,5] Adrenalectomy is a safe procedure and leads to acceptable survival rates even after LT. [6] However, metastasis from HCC to the seminal vesicle has only been reported once but only in a patient with HCC that did not receive LT. [7]…”