NEW YORK (Reuters Health) Jan 16 - Despite evidence supporting adrenal-sparing surgery, ipsilateral adrenalectomy remains common during radical nephrectomy for cancer, researchers from Canada report.
"Although adrenal sparing surgery has been stated in urologic guidelines, we know that guidelines are not necessarily the most effective means of encouraging change," Dr. Antonio Finelli from the University of Toronto told Reuters Health by email.
"Therefore, alternate strategies such as audit and feedback, although untested in this field, may be required to expedite uptake in the rapidly changing landscape of surgery for renal cancer," he added.
Dr. Finelli and colleagues, whose findings were published online December 15 in The Journal of Urology, reviewed pathology reports for more than 5,000 patients in the Ontario Cancer Registry who had undergone radical nephrectomy for renal cell carcinoma.
Although only 74 cases (1.4%) had adrenal involvement, the overall adrenalectomy rate was 40.1%. This rate decreased only slightly after studies appeared in support of adrenal-sparing surgery, from 40.6% in 1995 to 34.8% in 2004.
Adrenalectomy was performed in 51% of cases with tumors larger than 7 cm versus 30% of cases with tumors smaller than 4 cm. The adrenal gland was involved in just 3.2% of the larger tumors and 0.6% of the smaller tumors. Just under 1% of intermediate-sized tumors (4 to 7 cm) had adrenal involvement.
Besides increased tumor size, adrenal involvement was significantly higher when there was fat invasion of the tumor.
One-year and five-year survival rates were significantly lower with adrenal involvement (60.6% and 21.6%, respectively) than without adrenal involvement (91.5% and 77.9%, respectively).
"Ipsilateral adrenalectomy at the time (of) nephrectomy continues to be performed regardless of evidence to suggest that adrenal involvement is rare in most instances," Dr. Finelli concluded.
"Although there is no data to suggest that loss of an adrenal gland has significant physiologic consequences, in the setting of kidney cancer, contralateral adrenal involvement may occur at a later date necessitating surgery and lifelong steroid replacement," he added. "We are in the process of investigating the physiologic impact if any of adrenalectomy in patients with renal cancer."
SOURCE: http://bit.ly/y3S60q
J Urol 2012;187:398-404.
"Although adrenal sparing surgery has been stated in urologic guidelines, we know that guidelines are not necessarily the most effective means of encouraging change," Dr. Antonio Finelli from the University of Toronto told Reuters Health by email.
"Therefore, alternate strategies such as audit and feedback, although untested in this field, may be required to expedite uptake in the rapidly changing landscape of surgery for renal cancer," he added.
Dr. Finelli and colleagues, whose findings were published online December 15 in The Journal of Urology, reviewed pathology reports for more than 5,000 patients in the Ontario Cancer Registry who had undergone radical nephrectomy for renal cell carcinoma.
Although only 74 cases (1.4%) had adrenal involvement, the overall adrenalectomy rate was 40.1%. This rate decreased only slightly after studies appeared in support of adrenal-sparing surgery, from 40.6% in 1995 to 34.8% in 2004.
Adrenalectomy was performed in 51% of cases with tumors larger than 7 cm versus 30% of cases with tumors smaller than 4 cm. The adrenal gland was involved in just 3.2% of the larger tumors and 0.6% of the smaller tumors. Just under 1% of intermediate-sized tumors (4 to 7 cm) had adrenal involvement.
Besides increased tumor size, adrenal involvement was significantly higher when there was fat invasion of the tumor.
One-year and five-year survival rates were significantly lower with adrenal involvement (60.6% and 21.6%, respectively) than without adrenal involvement (91.5% and 77.9%, respectively).
"Ipsilateral adrenalectomy at the time (of) nephrectomy continues to be performed regardless of evidence to suggest that adrenal involvement is rare in most instances," Dr. Finelli concluded.
"Although there is no data to suggest that loss of an adrenal gland has significant physiologic consequences, in the setting of kidney cancer, contralateral adrenal involvement may occur at a later date necessitating surgery and lifelong steroid replacement," he added. "We are in the process of investigating the physiologic impact if any of adrenalectomy in patients with renal cancer."
SOURCE: http://bit.ly/y3S60q
J Urol 2012;187:398-404.
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου