Mental HealthThe Necessity Of Adrenalectomy At The Time Of Radical Nephrectomy: A Systematic Review
UroToday.com - To take the adrenal or not at the time of radical nephrectomy, that is the question. These researchers from New York University School of Medicine performed an extensive literature search to determine the role of adrenalectomy at radical nephrectomy and discovered that the incidence of solitary, synchronous, ipsilateral adrenal involvement, and therefore potentially curable tumor disease with ipsilateral adrenalectomy occurred extremely infrequently - in only 1% to 5% of cases.
Cross sectional imaging is now accurate at demonstrating the absence of adrenal involvement but still carries a significant risk of false positives. Disease-specific and overall survival of those patients undergoing radial nephrectomy, with or without adrenalectomy, is very similar. However, several characteristics on preoperative evaluation are associated with a greater risk of adrenal tumor involvement and these include both upper pole location of the renal tumor and size > 7 cm, multi-focality of the disease, venous thrombosis particularly at the level of the adrenal vein, and CT or MRI adrenal abnormality such as non-visualization, irregular borders, nodule, enlargement or contiguous infiltration.
Therefore it would appear that in the majority of patients, the apparent benefit of ipsilateral adrenalectomy does not support it as a standard practice in all patients who have otherwise normal imaging preoperatively. However in the 2% of patients who have isolated adrenal metastasis, the concomitant adrenalectomy may provide a survival advantage.
O"Malley RL, Godoy G, Kanofsky JA, Taneja SS
J Urol. 2009 May;181(5):2009-17.
doi:10.1016/j.juro.2009.01.018
Written by UroToday.com Contributing Editor Elspeth M. McDougall, MD, FRCSC, MHPE
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