肝浸潤を伴う転移性右副腎腫瘍に対して経腹膜および経後腹膜到達法併用により体腔鏡下切除しえた1例

Abstract

We report a case of metastatic adrenal tumor with liver invasion which was successfully resected by laparoscopic surgery using both intraperitoneal and retroperitoneal approaches. A man in his 70s was diagnosed with lung adenocarcinoma with mediastinal and supraclavicular nodes involvement accompanied with multiple brain metastases (cT1bN3M1c). After 4 courses of systemic chemotherapy (cisplatin + pemetrexed) and the radiation therapy to the brain metastases, tumor regression was observed in the primary tumor as well as all the metastatic lesions. After 13 months, a solitary metastasis developed to the right adrenal gland without progression of the primary and metastatic tumors. Tumor reduction was observed in the adrenal gland after the administration of pembrolizumab. However, the metastatic tumor eventually progressed and imaging studies revealed that the right adrenal metastasis invaded to the liver. Importantly, neither progression of the pre-existing tumors nor new metastasis was identified. Based on these findings, laparoscopic adrenalectomy and partial hepatectomy were performed using both intraperitoneal and retroperitoneal approaches. No recurrence was observed six months after the surgery.