Reconsideration of the Necessity of Routine Ipsilateral Adrenalectomy during Radical Nephrectomy for Renal Cell Carcinoma

Kim, Sung Ryong; Chung, Han; Kim, Se Joong

Abstract

PURPOSE: Adrenalectomy has traditionally been included as a component of the radical nephrectomy. However, its role remains controversial. We assessed the ipsilateral adrenal involvement in renal cell carcinoma to determine whether ipsilateral adrenalectomy during radical nephrectomy is essential.
MATERIALS AND METHODS
The records of 77 patients undergoing radical nephrectomy with ipsilateral adrenalectomy for renal cell carcinoma were reviewed. Radiographic findings were subsequently compared to postoperative histopathological findings to assess the predictive value of tumor characteristics and imaging in determining adrenal involvement.
RESULTS
Three patients (3.9%) had ipsilateral adrenal involvement. In one of these 3 patients, adrenal involvement was documented in preoperative CT scan. The other two, in whom there were no adrenal abnormalities in CT scan, showed renal vein thrombosis. All 3 patients had advanced stage (T3b or T4). Mean renal tumor size in patients with adrenal involvement was 13.7cm (8-24) compared to 5.9cm (1.5-18) in those without adrenal involvement. Two of 3 patients with adrenal involvement had the adrenal invasion by direct extension of tumor from the upper pole of the kidney and 1 patient by hematogenous metastasis.
CONCLUSIONS
Adrenalectomy may not be needed to perform routinely in localized, early stage renal cell carcinoma (T1-2), particularly when CT is negative for adrenal involvement. In renal cell carcinoma with risk factors, such as high stage (T3-4), large tumor involving the upper pole and renal vein thrombus, adrenalectomy should be performed.