Is Adrenalectomy a Necessary Component of Radical Nephrectomy? Ucla Experience With 511 Radical Nephrectomies

Abstract

With a low incidence of 0.6%, adrenal involvement is not likely in patients with localized, early stage renal cell carcinoma and adrenalectomy is unnecessary, particularly when CT is negative. In contrast, the 8.1% incidence of adrenal involvement with advanced renal cell carcinoma supports the need for adrenalectomy. Careful review of preoperative imaging is required to determine the need for adrenalectomy in patients at increased risk with high stage lesions, renal vein thrombus and upper pole or multifocal intrarenal tumors. With a negative predictive value of 99.4%, negative CT should decrease the need for adrenalectomy. In contrast, positive findings are less reliable given the relatively lower positive predictive value of this imaging modality. Although such positive findings may raise suspicion of adrenal involvement, they may not necessarily indicate adrenalectomy given the low incidence, unless renal cell carcinoma with risk factors, such as high stage, upper pole location, multifocality and renal vein thrombus, is present.

Adjuvant and Neoadjuvant Therapy in Renal Cell Carcinoma

“…It also prevents the loss of complete renal function, a factor that has been associated with a shorter OS [44]. Partial nephrectomies have also resulted in the restriction of adrenalectomy and lymphadenectomy to patients with disease stage of large tumors (> 7 cm) or radiologic evidence of adrenal involvement or lymphadenopathy [45,46]. However, NSS is still underutilized and ORN remains the most commonly performed approach [47].…”

Integrating metastasectomy and stereotactic radiosurgery in the treatment of metastatic renal cell carcinoma

“…It is unknown whether this is directly due to the adrenal involvement or a consequence of an often concomitant advanced locoregional tumour stage. In 347 patients with advanced stage disease (T3-4N0-1M0-1) adrenal metastases occurred in 8.1% [109]. Among 56 patients with adrenal metastases, 82% had pT3 tumours [108].…”

The Contemporary Role of Surgery in Kidney Cancer

“…The incidence of adrenal metastasis from rcc in contemporary series has been reported at 2.7%–5.7% 16–19. This low occurrence, coupled with modern imaging modalities, has led to many questions about the role of systematic adrenalectomy during radical nephrectomy as initially suggested by Robson.…”