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• W2116768698 abstract "No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Feb 2000IS ADRENALECTOMY A NECESSARY COMPONENT OF RADICAL NEPHRECTOMY? UCLA EXPERIENCE WITH 511 RADICAL NEPHRECTOMIES KE-HUNG TSUI, OLEG SHVARTS, ZORAN BARBARIC, ROBERT FIGLIN, JEAN B. de KERNION, and ARIE BELLDEGRUN KE-HUNG TSUIKE-HUNG TSUI More articles by this author , OLEG SHVARTSOLEG SHVARTS More articles by this author , ZORAN BARBARICZORAN BARBARIC More articles by this author , ROBERT FIGLINROBERT FIGLIN More articles by this author , JEAN B. de KERNIONJEAN B. de KERNION More articles by this author , and ARIE BELLDEGRUNARIE BELLDEGRUN More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)67895-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We determine the incidence and characteristics of adrenal involvement in localized and advanced renal cell carcinoma, and evaluate the role of adrenalectomy as part of radical nephrectomy. Materials and Methods: The records of 511 patients undergoing radical nephrectomy with ipsilateral adrenalectomy for renal cell carcinoma at our medical center between 1986 and 1998 were reviewed. Mean patient age was 63.2 years (range 38 to 85), and 78% of the subjects were males and 22% were females. Patients were divided into subgroups of 164 with localized (stage T1–2 tumor, group 1) and 347 with advanced (stage T3–4N01M01, group 2) renal cell carcinoma. Staging of tumors was performed according to the 1997 TNM guidelines. A retrospective review of preoperative computerized tomography (CT) of the abdomen was performed. Radiographic findings were subsequently compared to postoperative histopathological findings to assess the predictive value of tumor characteristics and imaging in determining adrenal metastasis. Results: Of the 511 patients 29 (5.7%) had adrenal involvement. Average size of the adrenal tumor was 3.86 cm. (standard deviation 1.89). Tumor stage correlated with probability of adrenal spread, with T4, T3 and T1–2 tumors accounting for 40%, 7.8% and 0.6% of cases, respectively. Upper pole intrarenal renal cell carcinoma most likely to spread was local extension to the adrenal glands, representing 58.6% of adrenal involvement. In contrast, multifocal, lower pole and mid region renal cell carcinoma tumors metastasized hematogenously, representing 32%, 7% and 4% of adrenal metastasis, respectively. The relationship between intrarenal tumor size (mean 8.9 cm., range 3 to 17) and adrenal involvement (independent of stage) was not statistically significant. Renal vein thrombus involvement was demonstrated in 8 of 12 cases (67%) with left and 2 of 9 (22%) with right adrenal involvement. Preoperative CT demonstrated 99.6% specificity, 99.4% negative predictive value, 89.6% sensitivity and 92.8% positive predictive value for adrenal involvement by renal cell carcinoma. Conclusions: With a low incidence of 0.6%, adrenal involvement is not likely in patients with localized, early stage renal cell carcinoma and adrenalectomy is unnecessary, particularly when CT is negative. In contrast, the 8.1% incidence of adrenal involvement with advanced renal cell carcinoma supports the need for adrenalectomy. Careful review of preoperative imaging is required to determine the need for adrenalectomy in patients at increased risk with high stage lesions, renal vein thrombus and upper pole or multifocal intrarenal tumors. With a negative predictive value of 99.4%, negative CT should decrease the need for adrenalectomy. In contrast, positive findings are less reliable given the relatively lower positive predictive value of this imaging modality. 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Google Scholar 21 : Adrenal involvement from renal cell carcinoma: predictive value of computerized tomography. J Urol1994; 152: 1082. Link, Google Scholar From the Departments of Urology, Medicine and Radiology, UCLA School of Medicine, Los Angeles, California© 2000 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited ByLaguna M (2018) Re: Systematic Review of Adrenalectomy and Lymph Node Dissection in Locally Advanced Renal Cell CarcinomaJournal of Urology, VOL. 191, NO. 6, (1728-1730), Online publication date: 1-Jun-2014.Yap S, Alibhai S, Abouassaly R, Timilshina N and Finelli A (2018) Do We Continue to Unnecessarily Perform Ipsilateral Adrenalectomy at the Time of Radical Nephrectomy? A Population Based StudyJournal of Urology, VOL. 187, NO. 2, (398-404), Online publication date: 1-Feb-2012.Kutikov A, Piotrowski Z, Canter D, Li T, Chen D, Viterbo R, Greenberg R, Boorjian S and Uzzo R (2018) Routine Adrenalectomy Is Unnecessary During Surgery for Large and/or Upper Pole Renal Tumors When the Adrenal Gland Is Radiographically NormalJournal of Urology, VOL. 185, NO. 4, (1198-1203), Online publication date: 1-Apr-2011.Moore K, Leslie B, Salle J, Braga L, Bägli D, Bolduc S and Lorenzo A (2010) Can We Spare Removing the Adrenal Gland at Radical Nephrectomy in Children With Wilms Tumor?Journal of Urology, VOL. 184, NO. 4S, (1638-1643), Online publication date: 1-Oct-2010.O'Malley R, Godoy G, Kanofsky J and Taneja S (2018) The Necessity of Adrenalectomy at the Time of Radical Nephrectomy: A Systematic ReviewJournal of Urology, VOL. 181, NO. 5, (2009-2017), Online publication date: 1-May-2009.THOMPSON R, LEIBOVICH B, CHEVILLE J, LOHSE C, FRANK I, KWON E, ZINCKE H and BLUTE M (2018) SHOULD DIRECT IPSILATERAL ADRENAL INVASION FROM RENAL CELL CARCINOMA BE CLASSIFIED AS pT3a?Journal of Urology, VOL. 173, NO. 3, (918-921), Online publication date: 1-Mar-2005.LAM J, SHVARTS O, LEPPERT J, FIGLIN R and BELLDEGRUN A (2018) RENAL CELL CARCINOMA 2005: NEW FRONTIERS IN STAGING, PROGNOSTICATION AND TARGETED MOLECULAR THERAPYJournal of Urology, VOL. 173, NO. 6, (1853-1862), Online publication date: 1-Jun-2005.SIEMER S, LEHMANN J, KAMRADT J, LOCH T, REMBERGER K, HUMKE U, ZIEGLER M and STÖCKLE M (2018) ADRENAL METASTASES IN 1,635 PATIENTS WITH RENAL CELL CARCINOMA: OUTCOME AND INDICATION FOR ADRENALECTOMYJournal of Urology, VOL. 171, NO. 6 Part 1, (2155-2159), Online publication date: 1-Jun-2004.HAN K, BUI M, PANTUCK A, FREITAS D, LEIBOVICH B, DOREY F, ZISMAN A, JANZEN N, MUKOUYAMA H, FIGLIN R and BELLDEGRUN A (2018) TNM T3a Renal Cell Carcinoma: Adrenal Gland Involvement is Not the Same as Renal Fat InvasionJournal of Urology, VOL. 169, NO. 3, (899-904), Online publication date: 1-Mar-2003.PANTUCK A, ZISMAN A, DOREY F, CHAO D, HAN K, SAID J, GITLITZ B, FIGLIN R and BELLDEGRUN A (2018) Renal Cell Carcinoma With Retroperitoneal Lymph Nodes: Role of Lymph Node DissectionJournal of Urology, VOL. 169, NO. 6, (2076-2083), Online publication date: 1-Jun-2003.Pantuck A, Zisman A and Belldegrun A (2018) Editorial commentJournal of Urology, VOL. 167, NO. 2 Part 2, (876-877), Online publication date: 1-Feb-2002.PAUL R, MORDHORST J, BUSCH R, LEYH H and HARTUNG R (2018) ADRENAL SPARING SURGERY DURING RADICAL NEPHRECTOMY IN PATIENTS WITH RENAL CELL CANCER: A NEW ALGORITHMJournal of Urology, VOL. 166, NO. 1, (59-62), Online publication date: 1-Jul-2001.PANTUCK A, ZISMAN A and BELLDEGRUN A (2018) THE CHANGING NATURAL HISTORY OF RENAL CELL CARCINOMAJournal of Urology, VOL. 166, NO. 5, (1611-1623), Online publication date: 1-Nov-2001.Freedland S and Belldegrun A (2018) EDITORIAL: TOWARDS KIDNEY CANCER CRYSTAL BALL. BETTER PROGNOSTICATION OF PATIENTS WITH RENAL CELL CARCINOMAJournal of Urology, VOL. 166, NO. 1, (73-74), Online publication date: 1-Jul-2001. Volume 163Issue 2February 2000Page: 437-441 Advertisement Copyright & Permissions© 2000 by American Urological Association, Inc.Keywordsrenal celladrenal glandscarcinomatomographyadrenalectomyemission-computedMetricsAuthor Information KE-HUNG TSUI More articles by this author OLEG SHVARTS More articles by this author ZORAN BARBARIC More articles by this author ROBERT FIGLIN More articles by this author JEAN B. de KERNION More articles by this author ARIE BELLDEGRUN More articles by this author Expand All Advertisement PDF DownloadLoading ..." @default.
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