Routine adrenalectomy in patients with locally advanced renal cell cancer does not offer oncologic benefit and places a significant portion of patients at risk for an asynchronous metastasis in a solitary adrenal gland

Christopher J. Weight, Simon P. Kim, Christine M. Lohse, John C. Cheville, R. Houston Thompson, Stephen A. Boorjian, Bradley C. Leibovich

Research output: Contribution to journalArticle

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Abstract

Background: The indications for the removal of the ipsilateral adrenal gland in patients with renal cell carcinoma (RCC) and the long-term outcomes have not been well studied. Objective: We evaluated the risk of synchronous and asynchronous adrenal involvement in patients with RCC and the effect of adrenalectomy on recurrence and survival in a large, single-institution cohort. Design, setting, and participants: From 1970 to 2006, 4018 consecutive patients with RCC treated by surgical extirpation (radical nephrectomy [RN]: 3107; partial nephrectomy [PN]: 911) from Mayo Clinic were studied for adrenal involvement. Risk of asynchronous adrenal metastasis and cancer-specific survival (CSS) were also compared between those who underwent concomitant ipsilateral adrenalectomy (n = 1541) and those who did not (n = 2477) using multivariate Cox models. Intervention: Surgical removal of the adrenal gland at the time of kidney tumor resection. Measurements: Primary outcome is cancer specific survival; secondary outcomes are incidence of synchronous and asynchronous adrenal metastases. Results and limitations: Median postoperative follow-up among those still alive was 8.2 yr (interquartile range [IQR]: 5.3-13.6). Synchronous ipsilateral adrenal involvement was rare (n = 88; 2.2%). Ipsilateral adrenalectomy at the time of nephrectomy did not lower the risk of subsequent adrenal metastasis (hazard ratio [HR]: 0.96; 95% confidence interval [CI], 0.64-1.42) or improve CSS (HR: 1.08; 95% CI, 0.95-1.22). The development of asynchronous adrenal metastasis occurred in 147 patients (3.7%) at a median of 3.7 yr (IQR: 1.2-7.7) after initial surgery. The risk of developing an ipsilateral versus a contralateral asynchronous adrenal metastasis was equivalent at 10 yr in those who did not undergo adrenalectomy at initial surgery. This study is limited by its single-institution, nonrandomized nature. Conclusions: Routine ipsilateral adrenalectomy in patients with high-risk features does not appear to offer any oncologic benefit while placing a significant portion of patients at risk for metastasis in a solitary adrenal gland. Therefore, adrenalectomy should only be performed with radiographic or intraoperative evidence of adrenal involvement.

Original languageEnglish (US)
Pages (from-to)458-464
Number of pages7
JournalEuropean Urology
Volume60
Issue number3
DOIs
StatePublished - Sep 2011

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Adrenalectomy
Adrenal Glands
Renal Cell Carcinoma
Neoplasm Metastasis
Nephrectomy
Survival
Adrenal Gland Neoplasms
Confidence Intervals
Neoplasms
Proportional Hazards Models
Kidney
Recurrence
Incidence

Keywords

  • Adrenalectomy
  • Partial nephrectomy
  • Radical nephrectomy
  • Renal cell cancer
  • Survival

ASJC Scopus subject areas

  • Urology

Cite this

Routine adrenalectomy in patients with locally advanced renal cell cancer does not offer oncologic benefit and places a significant portion of patients at risk for an asynchronous metastasis in a solitary adrenal gland. / Weight, Christopher J.; Kim, Simon P.; Lohse, Christine M.; Cheville, John C.; Thompson, R. Houston; Boorjian, Stephen A.; Leibovich, Bradley C.

In: European Urology, Vol. 60, No. 3, 09.2011, p. 458-464.

Research output: Contribution to journalArticle

Weight, Christopher J. ; Kim, Simon P. ; Lohse, Christine M. ; Cheville, John C. ; Thompson, R. Houston ; Boorjian, Stephen A. ; Leibovich, Bradley C. / Routine adrenalectomy in patients with locally advanced renal cell cancer does not offer oncologic benefit and places a significant portion of patients at risk for an asynchronous metastasis in a solitary adrenal gland. In: European Urology. 2011 ; Vol. 60, No. 3. pp. 458-464.
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abstract = "Background: The indications for the removal of the ipsilateral adrenal gland in patients with renal cell carcinoma (RCC) and the long-term outcomes have not been well studied. Objective: We evaluated the risk of synchronous and asynchronous adrenal involvement in patients with RCC and the effect of adrenalectomy on recurrence and survival in a large, single-institution cohort. Design, setting, and participants: From 1970 to 2006, 4018 consecutive patients with RCC treated by surgical extirpation (radical nephrectomy [RN]: 3107; partial nephrectomy [PN]: 911) from Mayo Clinic were studied for adrenal involvement. Risk of asynchronous adrenal metastasis and cancer-specific survival (CSS) were also compared between those who underwent concomitant ipsilateral adrenalectomy (n = 1541) and those who did not (n = 2477) using multivariate Cox models. Intervention: Surgical removal of the adrenal gland at the time of kidney tumor resection. Measurements: Primary outcome is cancer specific survival; secondary outcomes are incidence of synchronous and asynchronous adrenal metastases. Results and limitations: Median postoperative follow-up among those still alive was 8.2 yr (interquartile range [IQR]: 5.3-13.6). Synchronous ipsilateral adrenal involvement was rare (n = 88; 2.2{\%}). Ipsilateral adrenalectomy at the time of nephrectomy did not lower the risk of subsequent adrenal metastasis (hazard ratio [HR]: 0.96; 95{\%} confidence interval [CI], 0.64-1.42) or improve CSS (HR: 1.08; 95{\%} CI, 0.95-1.22). The development of asynchronous adrenal metastasis occurred in 147 patients (3.7{\%}) at a median of 3.7 yr (IQR: 1.2-7.7) after initial surgery. The risk of developing an ipsilateral versus a contralateral asynchronous adrenal metastasis was equivalent at 10 yr in those who did not undergo adrenalectomy at initial surgery. This study is limited by its single-institution, nonrandomized nature. Conclusions: Routine ipsilateral adrenalectomy in patients with high-risk features does not appear to offer any oncologic benefit while placing a significant portion of patients at risk for metastasis in a solitary adrenal gland. Therefore, adrenalectomy should only be performed with radiographic or intraoperative evidence of adrenal involvement.",
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T1 - Routine adrenalectomy in patients with locally advanced renal cell cancer does not offer oncologic benefit and places a significant portion of patients at risk for an asynchronous metastasis in a solitary adrenal gland

AU - Weight, Christopher J.

AU - Kim, Simon P.

AU - Lohse, Christine M.

AU - Cheville, John C.

AU - Thompson, R. Houston

AU - Boorjian, Stephen A.

AU - Leibovich, Bradley C.

PY - 2011/9

Y1 - 2011/9

N2 - Background: The indications for the removal of the ipsilateral adrenal gland in patients with renal cell carcinoma (RCC) and the long-term outcomes have not been well studied. Objective: We evaluated the risk of synchronous and asynchronous adrenal involvement in patients with RCC and the effect of adrenalectomy on recurrence and survival in a large, single-institution cohort. Design, setting, and participants: From 1970 to 2006, 4018 consecutive patients with RCC treated by surgical extirpation (radical nephrectomy [RN]: 3107; partial nephrectomy [PN]: 911) from Mayo Clinic were studied for adrenal involvement. Risk of asynchronous adrenal metastasis and cancer-specific survival (CSS) were also compared between those who underwent concomitant ipsilateral adrenalectomy (n = 1541) and those who did not (n = 2477) using multivariate Cox models. Intervention: Surgical removal of the adrenal gland at the time of kidney tumor resection. Measurements: Primary outcome is cancer specific survival; secondary outcomes are incidence of synchronous and asynchronous adrenal metastases. Results and limitations: Median postoperative follow-up among those still alive was 8.2 yr (interquartile range [IQR]: 5.3-13.6). Synchronous ipsilateral adrenal involvement was rare (n = 88; 2.2%). Ipsilateral adrenalectomy at the time of nephrectomy did not lower the risk of subsequent adrenal metastasis (hazard ratio [HR]: 0.96; 95% confidence interval [CI], 0.64-1.42) or improve CSS (HR: 1.08; 95% CI, 0.95-1.22). The development of asynchronous adrenal metastasis occurred in 147 patients (3.7%) at a median of 3.7 yr (IQR: 1.2-7.7) after initial surgery. The risk of developing an ipsilateral versus a contralateral asynchronous adrenal metastasis was equivalent at 10 yr in those who did not undergo adrenalectomy at initial surgery. This study is limited by its single-institution, nonrandomized nature. Conclusions: Routine ipsilateral adrenalectomy in patients with high-risk features does not appear to offer any oncologic benefit while placing a significant portion of patients at risk for metastasis in a solitary adrenal gland. Therefore, adrenalectomy should only be performed with radiographic or intraoperative evidence of adrenal involvement.

AB - Background: The indications for the removal of the ipsilateral adrenal gland in patients with renal cell carcinoma (RCC) and the long-term outcomes have not been well studied. Objective: We evaluated the risk of synchronous and asynchronous adrenal involvement in patients with RCC and the effect of adrenalectomy on recurrence and survival in a large, single-institution cohort. Design, setting, and participants: From 1970 to 2006, 4018 consecutive patients with RCC treated by surgical extirpation (radical nephrectomy [RN]: 3107; partial nephrectomy [PN]: 911) from Mayo Clinic were studied for adrenal involvement. Risk of asynchronous adrenal metastasis and cancer-specific survival (CSS) were also compared between those who underwent concomitant ipsilateral adrenalectomy (n = 1541) and those who did not (n = 2477) using multivariate Cox models. Intervention: Surgical removal of the adrenal gland at the time of kidney tumor resection. Measurements: Primary outcome is cancer specific survival; secondary outcomes are incidence of synchronous and asynchronous adrenal metastases. Results and limitations: Median postoperative follow-up among those still alive was 8.2 yr (interquartile range [IQR]: 5.3-13.6). Synchronous ipsilateral adrenal involvement was rare (n = 88; 2.2%). Ipsilateral adrenalectomy at the time of nephrectomy did not lower the risk of subsequent adrenal metastasis (hazard ratio [HR]: 0.96; 95% confidence interval [CI], 0.64-1.42) or improve CSS (HR: 1.08; 95% CI, 0.95-1.22). The development of asynchronous adrenal metastasis occurred in 147 patients (3.7%) at a median of 3.7 yr (IQR: 1.2-7.7) after initial surgery. The risk of developing an ipsilateral versus a contralateral asynchronous adrenal metastasis was equivalent at 10 yr in those who did not undergo adrenalectomy at initial surgery. This study is limited by its single-institution, nonrandomized nature. Conclusions: Routine ipsilateral adrenalectomy in patients with high-risk features does not appear to offer any oncologic benefit while placing a significant portion of patients at risk for metastasis in a solitary adrenal gland. Therefore, adrenalectomy should only be performed with radiographic or intraoperative evidence of adrenal involvement.

KW - Adrenalectomy

KW - Partial nephrectomy

KW - Radical nephrectomy

KW - Renal cell cancer

KW - Survival

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JF - European Urology

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