NEW YORK (Reuters Health) Mar 02 - Adrenal involvement is rare in cases of renal cell carcinoma, even when the tumor is large or in the upper pole. Therefore, concurrent adrenalectomy is not usually necessary, researchers report.
Writing in the April issue of the Journal of Urology published online February 22, lead author Dr. Alexander Kutikov and colleagues at the Fox Chase Cancer Center in Philadelphia, Pennsylvania, note that concurrent adrenalectomy during surgery for renal cell carcinoma was once routine.
"Over the recent decades, however, the necessity of adrenalectomy at the time of nephrectomy has been questioned," Dr. Kutikov told Reuters Health via email.
Recent recommendations indicate that adrenalectomy should be reserved for large tumors of 7 cm or more located in the upper pole. "We felt that this recommendation stemmed largely from historical 'inertia,'" said Dr. Kutikov. "In this study we examined whether the recommendation is in fact valid."
The team evaluated adrenal involvement in 179 patients in the center's kidney cancer registry who had surgery for renal tumors 7 cm in size or larger. In this group, 91 underwent concurrent adrenalectomy at renal surgery.
The investigators report that pathological adrenal involvement was confirmed in only four of the 91 (4.4%). Furthermore, preoperative adrenal imaging had 100% sensitivity and 92% specificity in detecting adrenal involvement, with 100% negative predictive value.
Upper pole location didn't predict adrenal involvement, and there was no survival advantage among the patients who underwent adrenalectomy compared to those who did not, whether the disease was localized or had metastasized.
"Routine adrenalectomy even in patients with large and/or upper pole renal tumors does not appear to be required," Dr. Kutikov and colleagues conclude. "Modern radiographic imaging is extremely sensitive to detect adrenal pathology and should guide management decisions regarding the need for concurrent adrenalectomy."
Dr. Kutikov added: "Regardless of size and location of the renal tumor, the adrenal gland can be safely spared if preoperative imaging definitively rules out an abnormality in the adrenal gland in question."
J Urol. Posted online February 22, 2011. Abstract
Writing in the April issue of the Journal of Urology published online February 22, lead author Dr. Alexander Kutikov and colleagues at the Fox Chase Cancer Center in Philadelphia, Pennsylvania, note that concurrent adrenalectomy during surgery for renal cell carcinoma was once routine.
"Over the recent decades, however, the necessity of adrenalectomy at the time of nephrectomy has been questioned," Dr. Kutikov told Reuters Health via email.
Recent recommendations indicate that adrenalectomy should be reserved for large tumors of 7 cm or more located in the upper pole. "We felt that this recommendation stemmed largely from historical 'inertia,'" said Dr. Kutikov. "In this study we examined whether the recommendation is in fact valid."
The team evaluated adrenal involvement in 179 patients in the center's kidney cancer registry who had surgery for renal tumors 7 cm in size or larger. In this group, 91 underwent concurrent adrenalectomy at renal surgery.
The investigators report that pathological adrenal involvement was confirmed in only four of the 91 (4.4%). Furthermore, preoperative adrenal imaging had 100% sensitivity and 92% specificity in detecting adrenal involvement, with 100% negative predictive value.
Upper pole location didn't predict adrenal involvement, and there was no survival advantage among the patients who underwent adrenalectomy compared to those who did not, whether the disease was localized or had metastasized.
"Routine adrenalectomy even in patients with large and/or upper pole renal tumors does not appear to be required," Dr. Kutikov and colleagues conclude. "Modern radiographic imaging is extremely sensitive to detect adrenal pathology and should guide management decisions regarding the need for concurrent adrenalectomy."
Dr. Kutikov added: "Regardless of size and location of the renal tumor, the adrenal gland can be safely spared if preoperative imaging definitively rules out an abnormality in the adrenal gland in question."
J Urol. Posted online February 22, 2011. Abstract
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