Surgical treatment for late-appearing adrenal metastasis from gastric cancer: report of two cases
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WORLD JOURNAL OF SURGICAL ONCOLOGY
CASE REPORT
Open Access
Surgical treatment for late-appearing adrenal metastasis from gastric cancer: report of two cases Dong Jin Kim1, Jun Hyun Lee2 and Wook Kim1*
Abstract Adrenal metastasis following gastrectomy for gastric cancer is often encountered as part of advanced systemic dissemination, which is usually unresectable. Thus, there are very few published case reports describing metastasectomy for adrenal metastasis from gastric cancer. Herein we present our experience in treating two patients diagnosed and treated for adrenal metastasis 6 years following initial surgery for advanced gastric cancer (pT2bN1M0 and pT2bN0M0, respectively, according to the classification system set forth in the sixth edition of The TNM Classification of Malignant Tumours by the International Union against Cancer). They underwent successful en bloc R0 resections, followed by systemic chemotherapy with close postoperative follow-up for another recurrence, and have remained alive without recurrence for 1 year. These results suggest that active surgical treatment for resectable metastatic gastric cancer in the adrenal glands has an important role in prolonging survival in selected patients. Keywords: Adrenal gland neoplasm, Gastrectomy, Stomach neoplasm
Background Common recurrence patterns following curative resection for advanced gastric cancer (AGC) are peritoneal dissemination and hematogenous metastasis. The liver is the main focus among extraperitoneal metastases, and the lung is the secondary focus [1,2]. Although some autopsy studies have shown that 16% to 18% of patients with gastric cancer developed adrenal metastases [3,4], most occurred in connection with multiple synchronous metastases to other sites [5]. Herein we report the cases of two patients with late-onset single adrenal metastases 6 years after gastrectomy for AGC who underwent successful curative resection. Case presentations Case 1
A 51-year-old man visited our hospital for a regular postoperative follow-up examination for gastric cancer in April 2012. He had undergone a total gastrectomy for * Correspondence: [email protected] 1 Department of Surgery, Yeouido St Mary’s Hospital, The Catholic University of Korea, 62 Yeouido-dong, Yeongdeungpo-gu, Seoul 150-713, Korea Full list of author information is available at the end of the article
AGC on the cardia in September 2006 (pT2bN1M0, stage II, according to the classification system set forth in the sixth edition of The TNM Classification of Malignant Tumours by the International Union against Cancer (UICC) [6]). At that time, the histological examination revealed a poorly differentiated tubular adenocarcinoma that had infiltrated the subserosal layer. Thirty-five lymph nodes were retrieved, and one was metastatic. After an R0 resection, the patient received six cycles of cisplatin and 5-fluorouracil (5-FU) combination chemotherapy until March 2007. He was followed up regularly with tumor markers, abdominal computed tomography (CT) scans and positron emission tomog
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