Facebook
Twitter
LinkedIn
Email
 |
Checking for direct PDF access through Ovid | |
Excerpt
The objective of this study was to investigate the rationale for adrenalectomy in conjunction with radical nephrectomy for renal cell carcinoma. Adrenal metastases are reported in the range of 19-29% in autopsy series, but adrenal involvement is found in 2-10% of operative series in the absence of overt metastatic disease. The study is based on autopsy and operative series obtained from a single institution between 1985 and 1999. Data from 15 347 autopsies were analysed and renal cell cancer was identified in 272 subjects; the condition was clinically recognized in 144 and unrecognized in 128. Analysis of 639 radical nephrectomies revealed that adrenal metastases were present in nine patients (five men and four women). In the autopsy series, adrenal metastases were identified in 24 subjects (8.8%), 23 with clinically recognized renal cell carcinoma and one with clinically unrecognized disease; in five patients direct involvement from the upper pole of the kidney was observed. Ipsilateral metastatic involvement was observed in eight patients and bilateral involvement in seven cases. In the operative series, nine patients (1.4%) had adrenal involvement at the time of the operation. Ipsilateral involvement was seen in seven patients, contralateral disease in one patient and bilateral metastases in one patient. All patients subsequently developed diffuse metastatic disease. No difference in the mean renal tumour size was found between patients with and without metastatic disease in the adrenals (6.34 versus 7.23 cm, respectively). No side prevalence was observed (54 and 52% left renal tumours in patients with and without adrenal metastases, respectively). Adrenal metastases were observed in eight out of 93 patients with upper pole renal tumours (33% of all adrenal metastases) and in six out of 83 patients with renal tumour of the lower pole (25% of all adrenal metastases). Adrenal metastases were more common in patients with multiple renal tumours (five out of 30 patients, 16.7%; 20% of all adrenal metastases). Bilateral renal tumours were seen in 27 out of 30 patients with multiple tumours. Most adrenal metastases were seen in patients with T3a (eight out of 56 patients, 14.3%) and T3b (six out of 52 patients, 11.5%) renal tumours. Only one patient with T1 renal tumour had adrenal metastases. The incidence of adrenal metastases increased with tumour grade from 0% in grade 1 up to 18.7% in grade 3 tumours. All but one patient with adrenal metastases had venous involvement at the level of the renal tumour. Preoperative computed tomography scan correctly diagnosed adrenal involvement in eight out of nine patients with adrenal metastases. In conclusion, the authors suggest that adrenalectomy should be performed in conjunction with radical nephrectomy only in cases where there is radiographic evidence of adrenal involvement or infiltration from an upper pole tumour is possible.
