Surgical treatment of adrenal metastasis following hepatectomy for hepatocellular carcinoma.

In three patients who underwent hepatectomy for solitary hepatocellular carcinoma (HCC), adrenal metastases, on the right sides of two patients and the left side of the third were subsequently detected by ultrasonography (US) and/or computed tomography (CT), and successfully resected after an average interval of 16 months from hepatectomy. There were no metastatic lesions in the lung, lymph node or bone. Two patients, however, who were found to have metastasis in the right adrenal also had multiple small recurrent foci in the residual liver. The latter were controlled by arterial embolization therapy and the patients are alive at 12 and three months post-adrenalectomy. In the other patient, with left adrenal metastasis, the serum alphafetoprotein level of 3,000 ng/ml returned to normal and he is doing well three and a half years after adrenalectomy. Since there is no effective therapy for metastatic adrenal HCC after hepatectomy, surgery would appear to be indicated, should no other distant metastasis be recognized clinically.