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

Abstract

Background Extrahepatic manifestation of hepatocellular carcinoma (HCC) is rare and primarily affects lung, lymph nodes and bone. Metastases to the adrenal glands are relatively infrequent. This 25-year institutional experience aimed for an analysis of factors influencing survival in patients undergoing surgery for HCC adrenal metastasis. Methods A retrospective analysis of the institutional database of the Clinic for General-, Visceral- and Transplantation Surgery of the University Medical Center Mainz, Germany, was performed. Patients who underwent surgery for HCC adrenal metastases from January 1995 to June 2020 were included. Pre-, peri- and postoperative factors with potential influence on survival were assessed. Results In 16 patients (14 males, two females), one bilateral and 15 unilateral adrenalectomies were performed (13 metachronous, three synchronous). Thirteen operations were carried out via laparotomy, and three adrenalectomies were minimally invasive (two laparoscopic, one retroperitoneoscopic). Median overall survival (after HCC diagnosis) was 35 months, range: 5–198. Median post-resection survival (after adrenalectomy) was 15 months, range: 0–75. Overall survival was longer in patients with the primary HCC treatment being liver transplantation (median 66 months) or liver resection (median 51 months), compared to only palliative intended treatment of the primary with chemotherapy (median 35 months) or local ablation (median 23 months). Conclusions Surgery is a feasible treatment option for patients with adrenal metastases originating from HCC. In patients who underwent adrenalectomy for HCC adrenal metastasis, overall survival was superior, if primary HCC treatment was potentially curative (liver transplantation or resection).

Adrenalectomy in a Patient With Recurrent Hepatocellular Carcinoma in the Adrenal Gland: A Case Report

“…Some case reports indicated that RFA or TACE could be effective in treating adrenal metastasis [ 6 , 11 , 14 ]. Staubitz et al revealed that the survival rate following adrenalectomy was superior to that after chemotherapy or local ablation [ 4 ]. Other reports indicated that surgery could be a feasible treatment [ 1 , 3 , 14 - 16 ].…”

“…Due to the limited literature and absence of standardized therapeutic approaches, the accumulation of case series and reports is crucial for elucidating the successful management of such cases. Treatment options for adrenal metastasis from HCC include surgical removal [ 1 - 4 ], transcatheter arterial chemoembolization(TACE) [ 5 ], radiofrequency ablation (RFA) [ 6 , 7 ], radiation [ 8 ], percutaneous ethanol injection therapy (PEIT), or systemic therapy [ 4 , 7 , 9 , 10 ]. Herein, we report a case of a single left adrenal metastasis due to recurrence after right hepatectomy for HCC, which was resected with good results.…”

Favorable response to multimodal treatment in hepatocellular carcinoma with inferior vena cava and right atrial tumor thrombus and left adrenal gland metastasis

“…[60,61] For the therapy of advanced HCC patients with adrenal glands metastases, surgical resection, ablation, and RT have been reported. [62][63][64] RT is a good palliative therapy for advanced HCC patients with extrahepatic metastases. [65][66][67][68][69] In a multi-institutional retrospective study conducted in Korea, for advanced HCC patients with adrenal metastasis treated with RT, the ORR was 38.3%, disease stability was 93.6%, and the adverse events were minimal.…”

“…Advanced HCC with adrenal glands metastatic are not common and the incidence is in the range of 8.8% to 16.9% [60,61] . For the therapy of advanced HCC patients with adrenal glands metastases, surgical resection, ablation, and RT have been reported [62–64] . RT is a good palliative therapy for advanced HCC patients with extrahepatic metastases [65–69] .…”

Outcomes after Surgical Treatment of Metastatic Disease in the Adrenal Gland; Valuable for the Patient?

“…Studies showed conflicting data regarding the laterality of adrenal metastasis. Most studies described predominantly unilateral adrenal [ 13 , 26 , 30 , 31 ], although some studies reported comparable uni- and bilateral involvement [ 32 ] and few studies even reported mostly bilateral metastasis [ 33 ].…”