ADRENALECTOMY - STILL A MUST IN RADICAL RENAL SURGERY

Objective To investigate the incidence of adrenal involvement and surv ival in patients with renal cell carcinoma. Patients and methods A ret rospective, multicentre trial was initiated by the Austrian Associatio n of Urologic Oncology (AUG); between January 1980 and December 1984, 225 patients were eligible for the study. All patients had unilateral renal tumours and nephrectomies were performed either with (group A, 1 09 patients) or without (group B, 116 patients) adrenalectomy. The two groups were matched for sex, age, laterality and nodal status. The me an follow-up time was 78 months. Results The location of the intrarena l tumour had no significant effect on adrenal involvement. By univaria te and multivariate analysis (Cox's proportional hazards model) signif icant differences in outcome were found only for pT stages, The mean s urvival times of patients in group A were 122.9 months in those with s tage pT1/2, 76.6 months with stage pT3 and 75.3 months with stage pT4. In group B, survival times were 109 months in those with stage pT1/2 (not significant) and 111 months in stage pT3 (P=0.0076). Eight patien ts had adrenal involvement and died from their tumours after a median of 15.3 months (range 4-63), The slightly longer survival of patients in group B with stage T1/2 tumours and the significantly better surviv al of patients with stage T3 disease may be attributable to statistica l bias, but there was no benefit from adrenalectomy. Conclusion The ef fect of adrenalectomy on the prognosis was at best comparable to that of lymphadenectomy and no curative effect was demonstrated, The remova l of a healthy adrenal may be detrimental and cause subsequent problem s in those patients requiring hormone replacement.