Routine adrenalectomy is unnecessary during surgery for large and/or upper pole renal tumors when the adrenal gland is radiographically normal

Alexander Kutikov, Zachary J. Piotrowski, Daniel J. Canter, Tianyu Li, David Y T Chen, Rosalia Viterbo, Richard E. Greenberg, Stephen A. Boorjian, Robert G. Uzzo

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Purpose: Concurrent adrenalectomy during renal surgery for renal cell carcinoma was once routine. More recent data suggest that adrenalectomy should be reserved for tumors 7 cm or greater, particularly those involving the upper pole. We evaluated the radiographic and pathological incidence of adrenal involvement in patients undergoing renal surgery for renal cell carcinoma 7 cm or greater. Materials and Methods: Patients who underwent renal surgery for tumors 7 cm or greater between 1999 and 2008 were identified from our kidney cancer registry. We used Fisher's exact test to determine whether radiographic tumor site predicted adrenal involvement. The Kaplan-Meier method and Cox proportional hazard regression models were used to analyze the impact of adrenal resection on outcome. Results: Of 1,650 patients we identified 179 patients who underwent surgery for renal cell carcinoma 7 cm or greater. Of these patients 91 underwent concurrent total ipsilateral adrenalectomy at renal surgery with pathological adrenal involvement confirmed in 4 (4.4%). Upper pole site did not predict involvement (p = 0.83). Preoperative adrenal imaging was 100% sensitive and 92% specific to detect adrenal involvement by renal cell carcinoma with 100% negative predictive value. No survival advantage was noted on multivariate analysis when comparing patients who underwent adrenal resection to 88 in whom the adrenal gland was spared (p = 0.38). Conclusions: Synchronous ipsilateral adrenal involvement with renal cell carcinoma is rare even in cases of large and/or upper pole tumors, making routine adrenalectomy unnecessary. Preoperative adrenal imaging is highly sensitive and should inform the decision to perform adrenalectomy more than tumor size or site.

Original languageEnglish (US)
Pages (from-to)1198-1203
Number of pages6
JournalJournal of Urology
Volume185
Issue number4
DOIs
StatePublished - Apr 2011
Externally publishedYes

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Unnecessary Procedures
Adrenalectomy
Adrenal Glands
Renal Cell Carcinoma
Kidney
Neoplasms
Kidney Neoplasms
Proportional Hazards Models
Registries
Multivariate Analysis
Survival
Incidence

Keywords

  • adrenal glands
  • adrenalectomy
  • carcinoma
  • kidney
  • mortality
  • renal cell

ASJC Scopus subject areas

  • Urology

Cite this

Routine adrenalectomy is unnecessary during surgery for large and/or upper pole renal tumors when the adrenal gland is radiographically normal. / Kutikov, Alexander; Piotrowski, Zachary J.; Canter, Daniel J.; Li, Tianyu; Chen, David Y T; Viterbo, Rosalia; Greenberg, Richard E.; Boorjian, Stephen A.; Uzzo, Robert G.

In: Journal of Urology, Vol. 185, No. 4, 04.2011, p. 1198-1203.

Research output: Contribution to journalArticle

Kutikov, A, Piotrowski, ZJ, Canter, DJ, Li, T, Chen, DYT, Viterbo, R, Greenberg, RE, Boorjian, SA & Uzzo, RG 2011, 'Routine adrenalectomy is unnecessary during surgery for large and/or upper pole renal tumors when the adrenal gland is radiographically normal', Journal of Urology, vol. 185, no. 4, pp. 1198-1203. https://doi.org/10.1016/j.juro.2010.11.090
Kutikov, Alexander ; Piotrowski, Zachary J. ; Canter, Daniel J. ; Li, Tianyu ; Chen, David Y T ; Viterbo, Rosalia ; Greenberg, Richard E. ; Boorjian, Stephen A. ; Uzzo, Robert G. / Routine adrenalectomy is unnecessary during surgery for large and/or upper pole renal tumors when the adrenal gland is radiographically normal. In: Journal of Urology. 2011 ; Vol. 185, No. 4. pp. 1198-1203.
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AU - Kutikov, Alexander

AU - Piotrowski, Zachary J.

AU - Canter, Daniel J.

AU - Li, Tianyu

AU - Chen, David Y T

AU - Viterbo, Rosalia

AU - Greenberg, Richard E.

AU - Boorjian, Stephen A.

AU - Uzzo, Robert G.

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N2 - Purpose: Concurrent adrenalectomy during renal surgery for renal cell carcinoma was once routine. More recent data suggest that adrenalectomy should be reserved for tumors 7 cm or greater, particularly those involving the upper pole. We evaluated the radiographic and pathological incidence of adrenal involvement in patients undergoing renal surgery for renal cell carcinoma 7 cm or greater. Materials and Methods: Patients who underwent renal surgery for tumors 7 cm or greater between 1999 and 2008 were identified from our kidney cancer registry. We used Fisher's exact test to determine whether radiographic tumor site predicted adrenal involvement. The Kaplan-Meier method and Cox proportional hazard regression models were used to analyze the impact of adrenal resection on outcome. Results: Of 1,650 patients we identified 179 patients who underwent surgery for renal cell carcinoma 7 cm or greater. Of these patients 91 underwent concurrent total ipsilateral adrenalectomy at renal surgery with pathological adrenal involvement confirmed in 4 (4.4%). Upper pole site did not predict involvement (p = 0.83). Preoperative adrenal imaging was 100% sensitive and 92% specific to detect adrenal involvement by renal cell carcinoma with 100% negative predictive value. No survival advantage was noted on multivariate analysis when comparing patients who underwent adrenal resection to 88 in whom the adrenal gland was spared (p = 0.38). Conclusions: Synchronous ipsilateral adrenal involvement with renal cell carcinoma is rare even in cases of large and/or upper pole tumors, making routine adrenalectomy unnecessary. Preoperative adrenal imaging is highly sensitive and should inform the decision to perform adrenalectomy more than tumor size or site.

AB - Purpose: Concurrent adrenalectomy during renal surgery for renal cell carcinoma was once routine. More recent data suggest that adrenalectomy should be reserved for tumors 7 cm or greater, particularly those involving the upper pole. We evaluated the radiographic and pathological incidence of adrenal involvement in patients undergoing renal surgery for renal cell carcinoma 7 cm or greater. Materials and Methods: Patients who underwent renal surgery for tumors 7 cm or greater between 1999 and 2008 were identified from our kidney cancer registry. We used Fisher's exact test to determine whether radiographic tumor site predicted adrenal involvement. The Kaplan-Meier method and Cox proportional hazard regression models were used to analyze the impact of adrenal resection on outcome. Results: Of 1,650 patients we identified 179 patients who underwent surgery for renal cell carcinoma 7 cm or greater. Of these patients 91 underwent concurrent total ipsilateral adrenalectomy at renal surgery with pathological adrenal involvement confirmed in 4 (4.4%). Upper pole site did not predict involvement (p = 0.83). Preoperative adrenal imaging was 100% sensitive and 92% specific to detect adrenal involvement by renal cell carcinoma with 100% negative predictive value. No survival advantage was noted on multivariate analysis when comparing patients who underwent adrenal resection to 88 in whom the adrenal gland was spared (p = 0.38). Conclusions: Synchronous ipsilateral adrenal involvement with renal cell carcinoma is rare even in cases of large and/or upper pole tumors, making routine adrenalectomy unnecessary. Preoperative adrenal imaging is highly sensitive and should inform the decision to perform adrenalectomy more than tumor size or site.

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