Objectives: Adrenalectomy is a part of radical nephrectomy because of the surgical oncology principle of a ‘wide margin beyond the malignancy’ and due to concern over possible metastases to the ipsilateral adrenal gland, especially in upper pole tumors. But, neither the frequency, predisposing factors of the renal cell carcinoma nor mechanisms of involvement of the adrenal gland are well defined. We assessed the ipsilateral adrenal involvement in renal cell carcinoma to determine whether ipsilateral adrenalectomy during radical nephrectomy is essential. Material and Method: In a series of 15,347 autopsies in Jena from 1985 through 1996, 272 renal cell carcinoma with 24 adrenal metastases were found. In the same period 9 adrenal metastases were found in 639 radical nephrectomies. Contralateral and bilateral metastases were seen in 15 cases of the autopsy series and in 2 cases of the operative series. Results: The risk of adrenal metastases correlated with multifocal tumors, pleomorphic cell type, anaplastic growth pattern and tumors that were larger than 2.5 cm. Of the 24 renal cell carcinomas with adrenal metastases in the autopsy series, 23 had evidence of widespread disease and 22 had lymph node metastases. A preoperative abdominal computerized tomography was performed in all 9 patients of the operative series with renal cell carcinoma and adrenal involvement. The adrenal gland was considered abnormal in 8 of the 9 cases (88.9%). Only in 1 patient was the computerized tomography incorrectly interpreted as negative. Conclusion: We think adrenalectomy should only be performed if there is radiographic evidence of metastases in the adrenal gland or adrenal infiltration by a large upper-pole tumor is possible. Macroscopically normal adrenal glands should not be removed during tumor nephrectomy because the need and benefit of routine adrenalectomy are extremely limited.
Dr. Heiko Wunderlich, MD
Department of Urology
Friedrich Schiller University of Jena
Lessingstrasse 1, D–07740 Jena (Germany)
Tel. +49 3641 635206, Fax +49 3641 635003
Received: Received: April 23, 1998
Accepted after revision: August 25, 1998
Number of Print Pages : 5
Number of Figures : 0, Number of Tables : 1, Number of References : 19
Official Organ of the European Association of Urology
Vol. 35, No. 4, Year 1999 (Cover Date: April 1999)
Journal Editor: C.C. Schulman, Brussels
ISSN: 0302–2838 (print), 1421–993X (Online)
For additional information: http://www.karger.ch/journals/eur
Article / Publication Details
Published online: 3/29/1999
Issue release date: April 1999
Number of Print Pages: 5
Number of Figures: 0
Number of Tables: 1
ISSN: 0302-2838 (Print)
eISSN: 1421-993X (Online)
For additional information: http://www.karger.com/EUR
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