26 ROUTINE ADRENALECTOMY IS UNNECESSARY DURING SURGERY FOR RENAL CELL CARCINOMA (RCC) - EVEN FOR LARGE AND/OR UPPER POLE TUMORS (2010)

You have accessJournal of UrologyAdrenal: Surgery/Tumors/Benign and Malignant Disease1 Apr 201026 ROUTINE ADRENALECTOMY IS UNNECESSARY DURING SURGERY FOR RENAL CELL CARCINOMA (RCC) - EVEN FOR LARGE AND/OR UPPER POLE TUMORS Alexander Kutikov, Zachary Piotrowski, Daniel J. Canter, Debra L. Kister, Samuel Litwin, David Y.T. Chen, Rosalia Viterbo, Richard E. Greenberg, Stephen A. Boorjian, and Robert G. Uzzo Alexander KutikovAlexander Kutikov Cherry Hill, NJ More articles by this author , Zachary PiotrowskiZachary Piotrowski Philadelphia, PA More articles by this author , Daniel J. CanterDaniel J. Canter Philadelphia, PA More articles by this author , Debra L. KisterDebra L. Kister Philadelphia, PA More articles by this author , Samuel LitwinSamuel Litwin Philadelphia, PA More articles by this author , David Y.T. ChenDavid Y.T. Chen Philadelphia, PA More articles by this author , Rosalia ViterboRosalia Viterbo Philadelphia, PA More articles by this author , Richard E. GreenbergRichard E. Greenberg Philadelphia, PA More articles by this author , Stephen A. BoorjianStephen A. Boorjian Philadelphia, PA More articles by this author , and Robert G. UzzoRobert G. Uzzo Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.070AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Routine adrenalectomy during surgery for RCC has been recommended for tumors >=7cm and particularly those in the upper pole[1]. We evaluated the incidence and predictors of adrenal involvement in patients undergoing radical nephrectomy (RN) for renal tumors >=7cm at our center. METHODS Patients undergoing RN with concurrent adrenalectomy for tumors >=7cm between 1999 and 2008 were identified from our prospectively-maintained institutional kidney cancer registry. Data regarding tumor location, pre-operative imaging, and pathological evaluation were analyzed. Fisher's exact test was utilized to determine whether tumor histology, pathological stage, tumor location or nodal/metastatic involvement predicted adrenal involvement. RESULTS Of the 1,650 patients in our kidney cancer database, we identified 91 cases (median age 62, range 48-83) with RCC measuring >=7 cm (median 9.5, range 7-24 cm) who underwent concurrent adrenalectomy at the time of RN (Table 1). The incidence of pathological adrenal involvement by RCC was 3.3% (3/91). Of these 3 patients, 2 had upper pole tumor location. Overall, 46 patients were definitively identified as having an upper pole tumor on pre-operative imaging. Upper pole location did not predict pathological adrenal involvement (p=0.66). On the other hand, adrenal radiographic abnormalities were seen in 11 patients, including the 3 who had pathologically-confirmed adrenal infiltration by RCC, yielding positive and negative predictive values of 27% and 100% respectively, and a 100% sensitivity and 91% specificity for detection of adrenal involvement on pre-operative imaging. TABLE 1. Clinicopathological demographics Variable N (%) Gender Male 69(75.8) Female 22(24.2) RCC histologic subtype Clear Cell 80(87.9) Papillary 3(3.3) Sarcomatoid 7(7.7) Chromophobe 1(1.1) Primary tumor stage T2 38(42.8) T3a 27(29.7) T3b/c 25(27.5) T4 1(1.1) Node Status Nx 21(23.0) N0 53(58.2) N1 6(6.6) N2 11(12.1) Metastatic Disease Status Mx/M0 69(75.8) M1 22(24.1) CONCLUSIONS While adrenalectomy continues to be recommended during nephrectomy for large and/or upper pole tumors, these guidelines have been conceived from heterogeneous cohorts[1]. Our data demonstrate that the adrenal gland is rarely involved even in cases of large upper pole renal masses and routine adrenal removal is unnecessary. We confirm previous reports that pre-operative imaging is highly sensitive and conclude that imaging alone – not tumor size nor location – should inform the decision for adrenalectomy at the time of RN. References 1 : J Urol2009; 181: 2009. Link, Google Scholar © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e11-e12 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.Metrics Author Information Alexander Kutikov Cherry Hill, NJ More articles by this author Zachary Piotrowski Philadelphia, PA More articles by this author Daniel J. Canter Philadelphia, PA More articles by this author Debra L. Kister Philadelphia, PA More articles by this author Samuel Litwin Philadelphia, PA More articles by this author David Y.T. Chen Philadelphia, PA More articles by this author Rosalia Viterbo Philadelphia, PA More articles by this author Richard E. Greenberg Philadelphia, PA More articles by this author Stephen A. Boorjian Philadelphia, PA More articles by this author Robert G. Uzzo Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...