The Need for Routine Ipsilateral Adrenalectomy during Radical Nephrectomy for Renal Cell Carcinoma

Ryu, Kwang Ho; Lee, Hyun Moo; Choi, Han Yong

Abstract

Purpose
The incidence and characteristics of ipsilateral adrenal involvement in patients with renal cell carcinoma (RCC) were assessed to determine whether a routine ipsilateral adrenalectomy is still required during radical nephrectomy.Materials and Methods: Between October 1994 and June 2003, the records of 543 patients with RCC, who underwent radical nephrectomy, were retrospectively reviewed. Patients were divided into two subgroups: 325 patients that had undergone a radical nephrectomy with ipsilateral adrenalectomy, and 218 with adrenal-sparing. The medical records, pathologic specimens, preoperative and postoperative computerized tomography (CT) finding were reviewed. The influence of an adrenalectomy on the disease- specific survival rate was also analyzed by the Kaplan-Meier method.
Results
There were no significant differences between the ipsilateral adrenalectomy and adrenal-sparing groups in terms of age, sex, location and T and M stages. There were no significant differences in the disease-specific survival rates between the two groups (p=0.092). Of the 325 patients with ipsilateral adrenalectomy, 12 (3.7%) had adrenal involvement, all of which were diagnosed as cT3 or greater, with 9 detected with preoperative CT. Preoperative CT had 75% sensitive, a 33% positive predictive value, 94.2% specificity and a 99% negative predictive value for adrenal involvement by RCC. Among patients without adrenal involvement, there were no significant differences in the disease-specific survival rates between patients with an ipsilateral adrenalectomy and adrenal-sparing.
Conclusions
A routine ipsilateral adrenalectomy during a radical nephrectomy does not improve the survival rate. A routine ipsilateral adrenalectomy may not be needed, particularly when no ipsilateral adrenal involvement is found to exist on the preoperative CT.