The need for routine adrenalectomy during the surgical treatment of renal cell cancer - the Hannover experience

Kuczyk, Markus A.; Münch, T.; Machtens, S.; Wefer, A.; Kondo, Mashahiko; Jonas, Udo

doi:10.1016/s1569-9056(02)80276-7

Cited by 12 publications

(17 citation statements)

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“…Moudouni et al [21] found that tumors with adrenal metastases were somewhat larger, which might suggest that increasing size is an expression of more rapidly growing and aggressive tumors. Recently, Kuczyk et al [22] reported the medical records on 819 patients and found the latest modification of the 1997 TNM system questionable, given the correlation between the risk of developing adrenal metastases and tumor size. They found metastatic spread to the adrenal gland in 6 patients with 5-to 7-cm tumors, in none of the tumors ^2.5 cm and in 3 with a maximum diameter of 2.5-5 cm.…”

Section: Discussionmentioning

confidence: 99%

“…In the description by Robson et al [1] in 1969, this procedure was recommended because of its relative sim- [13] 225 3 (1.9%) Abnormal CT; advanced, large, upper pole tumors Wunderlich et al [17] 639 9 (1.4%) Abnormal CT; macroscopically abnormal adrenals Tsui et al [23] 511 29 (5.7%) Risk factors (high stage, upper pole, multifocality, renal vein thrombus) von Knobloch et al [20] 589 19 (3.2%) All cases Kozak et al [8] 225 8 (3.5%) Abnormal CT; clear parenchymal margin of 1 cm Shalev et al [3] 285 11 (3.8%) Intraoperative suspicion Winter et al [14] 138 8 (5.8%) All cases Gill et al [27] 157 10 (6.4%) Abnormal CT Li et al [19] 129 9 (6.9%) 1 5 cm tumors Sawai et al [28] 73 2 (2.7%) Large tumors Paul et al [18] 866 27 (3.1%) Abnormal CT; 1 6 cm Kuczyk et al [22] 819 27 (3.3%) Abnormal CT; macroscopically abnormal adrenals plicity and adherence to the surgical oncology principle of a wide margin beyond the malignancy. Malignant involvement of the ipsilateral adrenal gland is noted in 1.2-10% of radical nephrectomy specimens at diagnosis [2] and 7-23% of disseminated renal cell carcinoma (RCC) cases at autopsy [3].…”

Section: Introductionmentioning

confidence: 99%

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Adrenalectomy: Defining Its Role in the Surgical Treatment of Renal Cell Carcinoma

Sio

Autorino²,

Lorenzo³

et al. 2003

Urol Int

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Objectives: With the recent widespread use of modern imaging techniques, the frequency of small low-stage renal cell carcinomas (RCC) has grown considerably, giving rise to more conservative surgical approaches. We evaluated the characteristics of adrenal involvement and the accuracy of computerized tomography (CT) in the diagnosis of RCC, defining the real need for adrenalectomy during surgical treatment. Methods: The medical records of 201 patients undergoing radical nephrectomy and ipsilateral adrenalectomy for localized or advanced RCC, from 1996 to 2002, were analyzed, retrospectively. We considered 76 with stage T1–2 disease and 125 with T3–4N0–1M0–1 disease. In all cases a blinded review of the preoperative abdominal CT was performed. Histopathology records of the surgical specimens were examined to determine the accuracy of the CT in identifying adrenal involvement by RCC. Results: The overall incidence of adrenal metastasis was 4.4%. The mean renal tumor size in patients with adrenal involvement was 7.8 cm. The tumor stage correlated with a probability of adrenal spread (p < 0.05), with T1–2 tumors accounting for 1.3% of cases only. The adrenal gland was diagnosed as abnormal on preoperative CT in 21 patients (10.4%). CT scan demonstrated 88.8% sensitivity, 92.1% specificity, 99.4% negative predictive value and 34.7% positive predictive value for adrenal involvement by RCC. Conclusions: Adrenal involvement is not likely in patients with localized early stage RCC and adrenalectomy can be omitted in such cases, particularly when CT is negative. However, in selected patients with large high-risk tumors, radical nephrectomy, including removal of the ipsilateral adrenal gland, should be performed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Adrenalectomy: Defining Its Role in the Surgical Treatment of Renal Cell Carcinoma

Sio

Autorino²,

Lorenzo³

et al. 2003

Urol Int

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“…Ipsilateral adrenal gland resection should be considered for patients with large upper pole tumors or abnormal-appearing adrenal glands on CT. [63][64][65] Adrenalectomy is not indicated when imaging shows a normal adrenal gland or if the tumor is not high-risk, based on size and location. 66 …”

Section: Adrenalectomymentioning

confidence: 99%

Kidney Cancer, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

Motzer¹,

Jonasch²,

Agarwal³

et al. 2017

J Natl Compr Canc Netw

511

516

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“…Ipsilateral adrenal gland resection should be considered for patients with large upper-pole tumors or abnormal-appearing adrenal glands seen on CT. [10][11][12] Adrenalectomy is not indicated when imaging shows a normal adrenal gland or if the tumor is not highrisk based on size and location.…”

Section: Treatment Of Localized Diseasementioning

confidence: 99%

Kidney Cancer

Motzer¹,

Agarwal²,

Beard³

et al. 2011

J Natl Compr Canc Netw

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An estimated 58,240 Americans were diagnosed with renal cancer and 13,040 died of the disease in the United States in 2010.1 Renal cell carcinoma (RCC) constitutes 2% to 3% of all malignancies, with a median age at diagnosis of 65 years. The rate of RCC has increased by 2% per year for the past 65 years. The reason for this increase is unknown. Approximately 90% of renal tumors are RCC, and 85% of these are clear cell tumors.2 Other less common cell types include papillary, chromophobe, and Bellini duct (collecting duct) tumors. Collecting duct carcinoma constitutes fewer than 1% of kidney cancer cases. Medullary renal carcinoma is a variant of collecting duct renal carcinoma and was described initially as occurring in patients who are sickle cell trait-positive.

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The need for routine adrenalectomy during the surgical treatment of renal cell cancer - the Hannover experience

Cited by 12 publications

References 0 publications

Adrenalectomy: Defining Its Role in the Surgical Treatment of Renal Cell Carcinoma

Adrenalectomy: Defining Its Role in the Surgical Treatment of Renal Cell Carcinoma

Kidney Cancer, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

Kidney Cancer

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