RECONSIDERING THE NECESSITY OF IPSILATERAL ADRENALECTOMY DURING RADICAL NEPHRECTOMY FOR RENAL-CELL CARCINOMA

Objectives Ipsilateral adrenalectomy is traditionally advocated as par t of radical nephrectomy performed for renal cell carcinoma. The curre nt study addresses the controversy of whether ipsilateral adrenalectom y should be performed routinely during radical nephrectomy. Methods. A total of 225 patients were treated surgically for renal cell carcinom a over an 18-year period. Of these patients, 158 underwent nephrectomy and simultaneous ipsilateral adrenalectomy and the other 67 had spari ng of the ipsilateral adrenal gland. A retrospective analysis of the m edical records and assessment of the clinical and the pathologic data were performed, Rates of survival and progression were evaluated in a subgroup of 109 patients, further subdivided into 54 patients who unde rwent concomitant adrenalectomy and 55 patients with the ipsilateral a drenal preserved during surgery. Results. Histopathologic abnormalitie s were detected in seven adrenal specimens (4.4%); however, only 3 pat ients (1.9%) had involvement of the adrenal by renal cell carcinoma. A ll cases of adrenal involvement were detected by the preoperative imag ing modalities. Ipsilateral adrenalectomy did not improve the outcome in comparison to adrenal preservation. Conclusions. In view of the rar ity of ipsilateral adrenal metastasis, the questionable prognostic mer its of concomitant adrenalectomy, and the availability of accurate ima ging modalities, we conclude that ipsilateral adrenalectomy is not nec essary in the majority of the patients undergoing radical nephrectomy for renal cell carcinoma.