The Modified Radical Nephrectomy: Is Ipsilateral Adrenalectomy a Necessary Component of Radical Nephrectomy In Localized RCC?

Moon, Du Geon; Cheon, Jun; Yoon, Duck Ki

Abstract

Despite the low incidence of adrenal involvement from renal cell carcinoma, ipsilateral adrenalectomy continues to be a standard part of radical nephrectomy at most medical centers. We reviewed retrospectively 51 patients treated with standard radical nephrectomy and 36 patients treated with modified radical nephrectomy sparing the ipsilateral adrenal gland. Histopathology confirmed malignant involvement of the adrenal in one patient who had evidence of adrenal involvement on the preoperative CT scan, and 50 patients who were normal on the preoperative CT scan didn`t have malignancy on their adrenal specimens. There were no malignant involvement of the adrenal on follow-up CT scan in 36 patients treated with sparing their adrenal and didn`t affected their prognosis and survival. These findings suggest that the ipsilateral adrenal gland need not be removed routinely as part of perifascial nephrectomy for renal cell carcinoma. For patients with middle and lower pole localized renal cell carcinoma who have normal findings on preoperative CT scans, modified radical nephrectomy sparing the adrenal gland may be a surgical alternative to radical nephrectomy.