Successful laparoscopic removal of a solitary adrenal metastasis from ovarian carcinoma: a case report

Synchronous adrenal metastasis and an inferior vena cava tumor thrombus from an ovarian carcinoma

A 60-year-old woman presented with synchronous adrenal metastasis and an inferior vena cava tumor thrombus in the adrenal vein that developed from an ovarian carcinoma. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and right adrenalectomy with caval tumor thrombectomy for treatment. Microscopic examination revealed a clear cell ovarian carcinoma and a metastatic adrenal tumor. The patient is clinically free of disease after 6 years of follow-up. There have been no reports of synchronous adrenal metastasis with an inferior vena cava thrombus that developed from an ovarian carcinoma. As several reports have described the long-term survival after adrenalectomy for the treatment of isolated adrenal metastasis, clinicians should be aware of this potential occurrence so that patients can be appropriately treated.

Laparoscopic adrenalectomy for suspected metastasis of adrenal glands: our experience

OBJECTIVES

To present our experience in laparoscopic adrenalectomy for isolated adrenal metastasis.

METHODS

A total of 34 adrenalectomies were performed in 32 patients for incidental adrenal masses discovered at primary tumor diagnosis or during follow-up. The primary tumors diagnosed were 13 cases of lung carcinoma, 9 of renal cell carcinoma, 2 of colorectal carcinoma, 2 of bladder carcinoma, and 1 each of ovarian carcinoma, breast cancer, gastric cancer, and melanoma. Two patients had no history of a primary tumor. The mean patient age was 59 years (range 26 to 75). The male/female ratio was 1.9:1.

RESULTS

The mean operative time was 87 minutes (range 40 to 240). The average blood loss was 89 mL (range 0 to 1000). No conversions to open surgery were needed. The mean hospital stay was 3 days (range 1 to 5). One intraoperative diaphragmatic lesion developed that was repaired laparoscopically, and 1 patient had a pancreatic fistula that was managed by percutaneous drainage. The mean tumor size was 4.3 cm (range 1.5 to 9). The microscopic analysis revealed 22 malign lesions (64.7%) and 12 cases of benign pathologic features (35.3%). The mean survival time was 26 months (range 4 to 64) for the 22 patients with malign lesions. In 2 patients (9.1%), the surgical margins were positive.

CONCLUSIONS

Laparoscopic adrenalectomy for small isolated metastases is feasible. However, because of the high risk of positive margins, this procedure should only be done by expert laparoscopists. We did not find a correlation between mass size and malignancy. Nevertheless, we believe that longer follow-up is mandatory before definitive conclusions can be drawn.

Role of surgical resection for lung, liver, and central nervous system metastases in patients with gynecological cancer: a literature review

Many reports of ovarian, cervical, and uterine cancers metastatic to lung, liver, and brain have been published. A fewer number of them focused on the surgical treatment for these patients. We reviewed the published literature, regarding surgical management of metastatic disease in patients with gynecological cancer. Some prognostic factors in the patients with metastatic lesions from these three different cancers were found in common. Favorable prognostic factors for a prolonged survival were good performance status of the patients, long disease-free interval, absence of other systemic disease, and the resectability, preferably with a clear margin. These factors should be considered as the criteria for surgery. In well-selected patients, survival could be extended from the surgical procedure with minimal complications. Other types of treatment such as radiation therapy or chemotherapy could also be given in conjunction with surgery, depending on tumor type and disease status of the primary cancer, other systemic diseases, and residual metastatic lesions after surgery.

Surgical advances in the treatment of ovarian cancer

Surgical intervention remains a key component in the diagnosis and management of epithelial ovarian carcinomas. Although the parameters defining "optimal" tumor cytoreduction continue to evolve, data validate the concept of complete operative tumor resection to no visible residual disease in all stages of ovarian cancer to prolong disease-free and overall survival. In select patients, recurrent disease also may be managed with surgical cytoreduction. At the other end of the spectrum, prophylactic bilateral salpingo-oophorectomy has been shown conclusively to reduce the risk of ovarian cancer in women at high risk. Although BRCA1-associated and BRCA2-associated gynecologic cancer syndromes do not seem to include uterine malignancies, the role of hysterectomy to remove the fallopian tube completely is controversial. Finally, new data support the concept of conservative, fertility-sparing surgery in a select group of women with early-stage disease. Although laparoscopy may be feasible in staging women with disease apparently limited to an ovary, further studies are necessary before it can be considered routinely as an alternative to standard laparotomy.