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Kutikov A , Piotrowski ZJ , Canter DJ , Li T , Chen DY , Viterbo R , Greenberg RE , Boorjian SA , Uzzo RG
Routine adrenalectomy is unnecessary during surgery for large and/or upper pole renal tumors when the adrenal gland is radiographically normal
J Urol. 2011 Apr;185(4) :1198-203
PMID: 21334029    PMCID: PMC3117661    URL: http://www.ncbi.nlm.nih.gov/pubmed/21334029
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Abstract
PURPOSE: Concurrent adrenalectomy during renal surgery for renal cell carcinoma was once routine. More recent data suggest that adrenalectomy should be reserved for tumors 7 cm or greater, particularly those involving the upper pole. We evaluated the radiographic and pathological incidence of adrenal involvement in patients undergoing renal surgery for renal cell carcinoma 7 cm or greater. MATERIALS AND METHODS: Patients who underwent renal surgery for tumors 7 cm or greater between 1999 and 2008 were identified from our kidney cancer registry. We used Fisher's exact test to determine whether radiographic tumor site predicted adrenal involvement. The Kaplan-Meier method and Cox proportional hazard regression models were used to analyze the impact of adrenal resection on outcome. RESULTS: Of 1,650 patients we identified 179 patients who underwent surgery for renal cell carcinoma 7 cm or greater. Of these patients 91 underwent concurrent total ipsilateral adrenalectomy at renal surgery with pathological adrenal involvement confirmed in 4 (4.4%). Upper pole site did not predict involvement (p = 0.83). Preoperative adrenal imaging was 100% sensitive and 92% specific to detect adrenal involvement by renal cell carcinoma with 100% negative predictive value. No survival advantage was noted on multivariate analysis when comparing patients who underwent adrenal resection to 88 in whom the adrenal gland was spared (p = 0.38). CONCLUSIONS: Synchronous ipsilateral adrenal involvement with renal cell carcinoma is rare even in cases of large and/or upper pole tumors, making routine adrenalectomy unnecessary. Preoperative adrenal imaging is highly sensitive and should inform the decision to perform adrenalectomy more than tumor size or site.
Notes
Kutikov, Alexander Piotrowski, Zachary J Canter, Daniel J Li, Tianyu Chen, David Y T Viterbo, Rosalia Greenberg, Richard E Boorjian, Stephen A Uzzo, Robert G P30 CA006927/CA/NCI NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S. United States The Journal of urology J Urol. 2011 Apr;185(4):1198-203. Epub 2011 Feb 22.