ADRENAL METASTASES FROM RENAL-CELL CARCINOMA - ROLE OF IPSILATERAL ADRENALECTOMY AND DEFINITION OF STAGE

Objectives. We undertook this study to establish criteria for adrenale ctomy in patients with renal cell carcinoma. Methods. We retrospective ly reviewed the records of 162 patients undergoing radical nephrectomy from 1979 to 1993 at University Hospitals of Cleveland. Simultaneous ipsilateral adrenalectomy was performed in 57 patients (35%). Results. Three of these 57 patients (5.3%) had ipsilateral adrenal metastases. All 3 patients had large, left-sided, upper-pole tumors that extended through the renal capsule (Stage T3a). All 3 patients with adrenal me tastases had progression to disseminated disease, with an average time to progression of 7.2 months, whereas only 13 (24%) of the 54 patient s without adrenal metastases developed metastatic disease (none to adr enal), with an average time to progression of 27.6 months. No patient with organ-confined disease (Stage T1 or T2) or extracapsular disease in the midkidney or lower pole had adrenal metastases identified histo logically. Conclusions. The prognosis is poor for renal cell carcinoma with ipsilateral adrenal involvement, even with complete removal. Bec ause of this poor prognosis, we believe that adrenal involvement shoul d constitute a separate stage category. We propose that patients with ipsilateral adrenal metastases via direct extension should be classifi ed as having pathologic Stage pT3d. If the patient has an ipsilateral adrenal metastasis not via direct extension, contralateral adrenal met astasis, or bilateral adrenal metastases, the pathologic stage should be M1. Ipsilateral adrenalectomy should only be performed if a lesion is seen preoperatively on computed tomographic scan or if gross diseas e is seen at the time of nephrectomy although its removal may not bene fit the patient. Copyright 1997 by Elsevier Science Inc.