Adrenalectomy for metastatic adrenal tumors

Abstract

The indications for adrenalectomy in cases of metastatic adrenal tumor remain controversial. To clarify indications and outcomes of adrenalectomy for adrenal metastasis, we performed a retrospective review of all 8 patients who underwent adrenalectomy for adrenal metastasis between 1990 and 2006 in Asahikawa Medical College Hospital. The Primary tumor was renal cell carcinoma in 2 cases, and eccrine poro carcinoma, rectal cancer, lung cancer, melanoma, bladder cancer and cancer of unknown origin in 1 case each. Open adrenalectomy was performed in all cases, including 1 case that was converted from laparoscopic adrenalectomy. Of the 4 patients with solitary adrenal metastasis, 3 were considered tumor-free after adrenalectomy, while the remaining patient was not due to unresectable primary tumor. Of the 3 patients with complete resection, one remained alive as of 88 months after adrenalectomy but was then lost to follow-up, and the other 2 patients remain alive 12 and 7 months after adrenalectomy. Of the 2 patients with other resectable metastasis who were tumor-free after removal of all metastases, one was alive 31 months postoperatively and the other died 23 months after operation. The remaining 2 cases with other unresectable metastasis died within 6 months after adrenalectomy. At least in cases of solitary adrenal metastasis, adrenalectomy can be effective if other valid methods are unavailable.

転移性副腎腫瘍に対する副腎摘除術の適応に関してはまだ統一された見解はない。そこでその適応と治療効果を明らかにするために, 1990年から2006年までの間に当院において転移性副腎腫瘍に対し副腎摘除術を施行した8症例についてretrospectiveに検討した。全例開腹にて副腎摘除を施行しており, 1例は腹腔鏡下摘出術からの移行であった。孤立性副腎転移は4例に認められ, 3例が術後tumor freeとなり得た。これら3例の観察期間はそれぞれ88, 12, 7ヵ月であった。副腎以外にも転移を認めたが, 副腎も含めてすべて外科的切除が可能であった2例はそれぞれ31, 23ヵ月の観察期間であった。副腎以外に切除不能な転移を認めた2例は6ヵ月以内に死亡した。他に有効な治療がない場合, 少なくとも孤立性副腎転移に関しては副腎摘除が有効な治療となる可能性があると思われた。(著者抄録)