BACKGROUND: The indications for the removal of the ipsilateral adrenal gland in patients with renal cell carcinoma (RCC) and the long-term outcomes have not been well studied. OBJECTIVE: We evaluated the risk of synchronous and asynchronous adrenal involvement in patients with RCC and the effect of adrenalectomy on recurrence and survival in a large, single-institution cohort. DESIGN, SETTING, AND PARTICIPANTS: From 1970 to 2006, 4018 consecutive patients with RCC treated by surgical extirpation (radical nephrectomy [RN]: 3107; partial nephrectomy [PN]: 911) from Mayo Clinic were studied for adrenal involvement. Risk of asynchronous adrenal metastasis and cancer-specific survival (CSS) were also compared between those who underwent concomitant ipsilateral adrenalectomy (n = 1541) and those who did not (n = 2477) using multivariate Cox models. INTERVENTION: Surgical removal of the adrenal gland at the time of kidney tumor resection. MEASUREMENTS: Primary outcome is cancer specific survival; secondary outcomes are incidence of synchronous and asynchronous adrenal metastases. RESULTS AND LIMITATIONS: Median postoperative follow-up among those still alive was 8.2 yr (interquartile range [IQR]: 5.3-13.6). Synchronous ipsilateral adrenal involvement was rare (n = 88; 2.2%). Ipsilateral adrenalectomy at the time of nephrectomy did not lower the risk of subsequent adrenal metastasis (hazard ratio [HR]: 0.96; 95% confidence interval [CI], 0.64-1.42) or improve CSS (HR: 1.08; 95% CI, 0.95-1.22). The development of asynchronous adrenal metastasis occurred in 147 patients (3.7%) at a median of 3.7 yr (IQR: 1.2-7.7) after initial surgery. The risk of developing an ipsilateral versus a contralateral asynchronous adrenal metastasis was equivalent at 10 yr in those who did not undergo adrenalectomy at initial surgery. This study is limited by its single-institution, nonrandomized nature. CONCLUSIONS: Routine ipsilateral adrenalectomy in patients with high-risk features does not appear to offer any oncologic benefit while placing a significant portion of patients at risk for metastasis in a solitary adrenal gland. Therefore, adrenalectomy should only be performed with radiographic or intraoperative evidence of adrenal involvement.
BACKGROUND: The indications for the removal of the ipsilateral adrenal gland in patients with renal cell carcinoma (RCC) and the long-term outcomes have not been well studied. OBJECTIVE: We evaluated the risk of synchronous and asynchronous adrenal involvement in patients with RCC and the effect of adrenalectomy on recurrence and survival in a large, single-institution cohort. DESIGN, SETTING, AND PARTICIPANTS: From 1970 to 2006, 4018 consecutive patients with RCC treated by surgical extirpation (radical nephrectomy [RN]: 3107; partial nephrectomy [PN]: 911) from Mayo Clinic were studied for adrenal involvement. Risk of asynchronous adrenal metastasis and cancer-specific survival (CSS) were also compared between those who underwent concomitant ipsilateral adrenalectomy (n = 1541) and those who did not (n = 2477) using multivariate Cox models. INTERVENTION: Surgical removal of the adrenal gland at the time of kidney tumor resection. MEASUREMENTS: Primary outcome is cancer specific survival; secondary outcomes are incidence of synchronous and asynchronous adrenal metastases. RESULTS AND LIMITATIONS: Median postoperative follow-up among those still alive was 8.2 yr (interquartile range [IQR]: 5.3-13.6). Synchronous ipsilateral adrenal involvement was rare (n = 88; 2.2%). Ipsilateral adrenalectomy at the time of nephrectomy did not lower the risk of subsequent adrenal metastasis (hazard ratio [HR]: 0.96; 95% confidence interval [CI], 0.64-1.42) or improve CSS (HR: 1.08; 95% CI, 0.95-1.22). The development of asynchronous adrenal metastasis occurred in 147 patients (3.7%) at a median of 3.7 yr (IQR: 1.2-7.7) after initial surgery. The risk of developing an ipsilateral versus a contralateral asynchronous adrenal metastasis was equivalent at 10 yr in those who did not undergo adrenalectomy at initial surgery. This study is limited by its single-institution, nonrandomized nature. CONCLUSIONS: Routine ipsilateral adrenalectomy in patients with high-risk features does not appear to offer any oncologic benefit while placing a significant portion of patients at risk for metastasis in a solitary adrenal gland. Therefore, adrenalectomy should only be performed with radiographic or intraoperative evidence of adrenal involvement.
Authors: Gregory J Nason; Leon G Walsh; Ciaran E Redmond; Niall P Kelly; Barry B McGuire; Vidit Sharma; Michael E Kelly; David J Galvin; David W Mulvin; Gerald M Lennon; David M Quinlan; Hugh D Flood; Subhasis K Giri Journal: Can Urol Assoc J Date: 2015-09-09 Impact factor: 1.862
Authors: Wassim M Bazzi; Daniel D Sjoberg; Michael A Feuerstein; Alexandra Maschino; Sweeney Verma; Melanie Bernstein; Matthew F O'Brien; Thomas Jang; William Lowrance; Robert J Motzer; Paul Russo Journal: J Urol Date: 2014-12-15 Impact factor: 7.450
Authors: Stanley A Yap; Shabbir M H Alibhai; David Margel; Robert Abouassaly; Narhari Timilshina; Antonio Finelli Journal: Can Urol Assoc J Date: 2013 Sep-Oct Impact factor: 1.862
Authors: Inga Peters; Milan Hora; Thomas R Herrmann; Christoph von Klot; Gerd Wegener; Petr Stransky; Ondrej Hes; Markus A Kuczyk; Axel S Merseburger Journal: Springerplus Date: 2013-07-01
Authors: Kathleen Kieran; James R Anderson; Jeffrey S Dome; Peter F Ehrlich; Michael L Ritchey; Robert C Shamberger; Elizabeth J Perlman; Daniel M Green; Andrew M Davidoff Journal: J Pediatr Surg Date: 2013-07 Impact factor: 2.545