Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Apr;185(4):1198-203.
doi: 10.1016/j.juro.2010.11.090. Epub 2011 Feb 22.

Routine adrenalectomy is unnecessary during surgery for large and/or upper pole renal tumors when the adrenal gland is radiographically normal

Alexander Kutikov  1 , Zachary J Piotrowski, Daniel J Canter, Tianyu Li, David Y T Chen, Rosalia Viterbo, Richard E Greenberg, Stephen A Boorjian, Robert G Uzzo
Affiliations

Routine adrenalectomy is unnecessary during surgery for large and/or upper pole renal tumors when the adrenal gland is radiographically normal

Alexander Kutikov et al. J Urol. 2011 Apr.

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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Comparison of overall survival for patients undergoing renal surgery with and without adrenal resection, stratified by (A) patients with distant disease (N+ and/or M+) and (B) patients with localized disease.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Robson CJ, Churchill BM, Anderson W. The results of radical nephrectomy for renal cell carcinoma. J Urol. 1969;101:297. - PubMed
    1. Campbell SC, Novick AC, Belldegrun A, et al. Guideline for management of the clinical T1 renal mass. J Urol. 2009;182:1271. - PubMed
    1. Lane BR, Tiong HY, Campbell SC, et al. Management of the adrenal gland during partial nephrectomy. J Urol. 2009;181:2430. - PubMed
    1. O’Malley RL, Godoy G, Kanofsky JA, et al. The necessity of adrenalectomy at the time of radical nephrectomy: a systematic review. J Urol. 2009;181:2009. - PubMed
    1. Campbell SC, Novick AC, Bukowski RM. Renal Tumors. In: Wein AJ, Kavoussi LR, Novick AC, et al., editors. Campbell-Walsh Urology. 9. Vol. 3. Philadelphia: Elsevier; 2007. pp. 1567–1637.

Publication types

MeSH terms