Adrenal Involvement from Renal Cell Carcinoma: Predictive Value of Computerized Tomography

Abstract

Although adrenal involvement from renal cell carcinoma is rare, removal of the adrenal during radical nephrectomy continues to be standard practice. To assess the actual need for adrenalectomy, we elected to evaluate whether malignant involvement of the adrenal gland could be reliably diagnosed preoperatively by a computerized tomogram (CT) of the abdomen. A blinded retrospective review of preoperative abdominal CT in 157 patients with renal cancer revealed an abnormality of the ipsilateral adrenal gland in 38. Histopathology confirmed malignant involvement of the adrenal in 10 patients. Significantly, all 119 adrenal glands judged to be normal on the preoperative CT were confirmed to be uninvolved by the renal cancer on histopathological study. We conclude that abdominal CT is reliable in the preoperative evaluation of the ipsilateral adrenal gland and assessment of its noninvolvement with renal carcinoma. In such cases adrenal sparing nephrectomy may be considered (76% of our patients). None of these 119 patients had either macroscopic or microscopic adrenal involvement. When the adrenal is not identified, displaced or enlarged on CT (24% of our patients) adrenalectomy should be routinely performed as part of radical nephrectomy. Even in this select group adrenal involvement was present in only 26% of the cases.

A population based study of surgeon characteristics associated with the uptake of contemporary techniques in renal surgery

“…Indications for ipsilateral adrenalectomy include high-risk tumour characteristics (higher T-stage, 18 larger diameter, 19 and upper pole location 20 ) or concern for adrenal involvement on preoperative imaging. 21 In appropriately selected patients, 10-year cancer-specific survival is equivalent whether or not the adrenal gland is removed. 5 Furthermore, unnecessary removal of the adrenal gland may be associated with significant morbidity related to adrenal insufficiency.…”

Comparative effectiveness of adrenal sparing radical nephrectomy and non-adrenal sparing radical nephrectomy in clear cell renal cell carcinoma: Observational study of survival outcomes

“…4,5 In RCC, nephron-sparing surgery is advocated in organ-confined disease where previously RN would have been routine practice. 10 Both anatomically and physiologically, the adrenal gland and kidney are completely different organs. Thus unnecessary removal of the adrenal gland is not justified.…”

Metachronous adrenal metastasis from operated contralateral renal cell carcinoma with adrenalectomy and iatrogenic Addison’s disease

“…Apart from this, adrenalectomy has no contribution to survival. 8 Some risk factors have been identified in terms of adrenal metastasis. Large renal masses, upper pole tumours, tumour arising from the left kidney, and multifocal tumours are risk factors for adrenal metastasis.…”