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. 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.

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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

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