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Long-term outcome of adrenalectomy for metastasis resulting from colorectal cancer with other metastatic sites: A report of 3 cases

View Article: PubMed Central - PubMed

ABSTRACT

Metastasis to the adrenal glands is a relatively frequent observation at autopsy of patients that have succumbed to cancer. Long-term disease-free survival has been reported in patients following the resection of solitary adrenal metastasis resulting from colorectal cancer. In addition, following primary resection for colorectal cancer, solitary metastasis to the adrenal glands is rare, even in outpatients at routine follow-ups. Therefore, adrenal metastasis is usually detected in combination with multiple synchronous metastases at other sites in the terminal stages of cancer. Between 1998 and 2002, 3 patients with adrenal metastasis and other synchronous metastatic sites underwent surgery for adrenal metastasis at the Department of Gastroenterological Surgery at Osaka University. The other synchronous metastatic sites observed in the 3 patients consisted of lung and para-aortic lymph nodes. In total, 2 out of the 3 patients experienced long-term disease-free survival for >5 years following surgery and 1 patient underwent curative resection for recurrence of metastases in the liver and right adrenal gland 79 months subsequent to the initial resection for adrenal metastasis. All 3 patients survived for >90 months. In conclusion, aggressive surgical resection for adrenal metastasis and other metastatic sites resulting from colorectal cancer may result in a survival benefit in selected patients.

No MeSH data available.


Related in: MedlinePlus

Patient 1. (A) Abdominal CT of local recurrence behind the bladder, indicated by an arrow. (B) Abdominal CT of an enlarged left adrenal gland, indicated by an arrow. (C) Alterations in the serum CEA levels of the patient. CT, computed tomography; CEA, serum carcinoembryonic antigen.
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f1-ol-0-0-4897: Patient 1. (A) Abdominal CT of local recurrence behind the bladder, indicated by an arrow. (B) Abdominal CT of an enlarged left adrenal gland, indicated by an arrow. (C) Alterations in the serum CEA levels of the patient. CT, computed tomography; CEA, serum carcinoembryonic antigen.

Mentions: In May 2000, a 63-year-old man presented with locally recurrent rectal cancer subsequent to an anterior peritoneal resection conducted in July 1998. According to the TNM classification (26,27), the pathological staging of the tumor in was stage IIIa [well-differentiated adenocarcinoma; pT3pN1M0; residual tumor (R) 0]. In May 2000, the CEA level of the patient had increased to 16 ng/ml (normal range, 0.0–4.0 ng/ml). An abdominal CT scan (Discovery CT750 HD; GE Healthcare, Piscataway, NJ, USA) identified the presence of local recurrence, which was posterior to the bladder. The patient refused treatment. The patient presented to hospital 1 year later with symptoms of anal pain and hematuria. The CEA level of the patient had increased to 110 ng/ml and the previously observed local recurrence had increased in size to a 60-mm diameter from an original size of 20-mm diameter (Fig. 1A). Beginning in July 2001, 40 Gy of external radiation in 20 fractions and 30 Gy of interstitial radiation therapy in 5 fractions was administered to the recurrent tumor. The CEA level of the patient (8 ng/ml) had decreased by October 2001. However, in August 2002, the CEA level of the patient increased to 11 ng/ml and an abdominal CT scan revealed left adrenal metastasis (Fig. 1B). The patient underwent laparoscopic left adrenalectomy. A pathological examination of the tumor demonstrated a well-differentiated adenocarcinoma consistent with primary CRC. The patient was followed up without adjuvant chemotherapy following adrenalectomy, and was alive and well at the last follow-up in April 2012, with no evidence of recurrence observed using positron emission tomography (PET)-CT (HEADTOME/set. 2400W; Shimadzu Co., Kyoto, Japan) and serum CEA, 9.5 years subsequent to the resection of the adrenal metastasis (Fig. 1C).


Long-term outcome of adrenalectomy for metastasis resulting from colorectal cancer with other metastatic sites: A report of 3 cases
Patient 1. (A) Abdominal CT of local recurrence behind the bladder, indicated by an arrow. (B) Abdominal CT of an enlarged left adrenal gland, indicated by an arrow. (C) Alterations in the serum CEA levels of the patient. CT, computed tomography; CEA, serum carcinoembryonic antigen.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998229&req=5

f1-ol-0-0-4897: Patient 1. (A) Abdominal CT of local recurrence behind the bladder, indicated by an arrow. (B) Abdominal CT of an enlarged left adrenal gland, indicated by an arrow. (C) Alterations in the serum CEA levels of the patient. CT, computed tomography; CEA, serum carcinoembryonic antigen.
Mentions: In May 2000, a 63-year-old man presented with locally recurrent rectal cancer subsequent to an anterior peritoneal resection conducted in July 1998. According to the TNM classification (26,27), the pathological staging of the tumor in was stage IIIa [well-differentiated adenocarcinoma; pT3pN1M0; residual tumor (R) 0]. In May 2000, the CEA level of the patient had increased to 16 ng/ml (normal range, 0.0–4.0 ng/ml). An abdominal CT scan (Discovery CT750 HD; GE Healthcare, Piscataway, NJ, USA) identified the presence of local recurrence, which was posterior to the bladder. The patient refused treatment. The patient presented to hospital 1 year later with symptoms of anal pain and hematuria. The CEA level of the patient had increased to 110 ng/ml and the previously observed local recurrence had increased in size to a 60-mm diameter from an original size of 20-mm diameter (Fig. 1A). Beginning in July 2001, 40 Gy of external radiation in 20 fractions and 30 Gy of interstitial radiation therapy in 5 fractions was administered to the recurrent tumor. The CEA level of the patient (8 ng/ml) had decreased by October 2001. However, in August 2002, the CEA level of the patient increased to 11 ng/ml and an abdominal CT scan revealed left adrenal metastasis (Fig. 1B). The patient underwent laparoscopic left adrenalectomy. A pathological examination of the tumor demonstrated a well-differentiated adenocarcinoma consistent with primary CRC. The patient was followed up without adjuvant chemotherapy following adrenalectomy, and was alive and well at the last follow-up in April 2012, with no evidence of recurrence observed using positron emission tomography (PET)-CT (HEADTOME/set. 2400W; Shimadzu Co., Kyoto, Japan) and serum CEA, 9.5 years subsequent to the resection of the adrenal metastasis (Fig. 1C).

View Article: PubMed Central - PubMed

ABSTRACT

Metastasis to the adrenal glands is a relatively frequent observation at autopsy of patients that have succumbed to cancer. Long-term disease-free survival has been reported in patients following the resection of solitary adrenal metastasis resulting from colorectal cancer. In addition, following primary resection for colorectal cancer, solitary metastasis to the adrenal glands is rare, even in outpatients at routine follow-ups. Therefore, adrenal metastasis is usually detected in combination with multiple synchronous metastases at other sites in the terminal stages of cancer. Between 1998 and 2002, 3 patients with adrenal metastasis and other synchronous metastatic sites underwent surgery for adrenal metastasis at the Department of Gastroenterological Surgery at Osaka University. The other synchronous metastatic sites observed in the 3 patients consisted of lung and para-aortic lymph nodes. In total, 2 out of the 3 patients experienced long-term disease-free survival for >5 years following surgery and 1 patient underwent curative resection for recurrence of metastases in the liver and right adrenal gland 79 months subsequent to the initial resection for adrenal metastasis. All 3 patients survived for >90 months. In conclusion, aggressive surgical resection for adrenal metastasis and other metastatic sites resulting from colorectal cancer may result in a survival benefit in selected patients.

No MeSH data available.


Related in: MedlinePlus