Radical nephrectomy for renal cell carcinoma: Is adrenalectomy necessary?

Objectives: The role of simultaneous adrenalectomy in combination with radi cal nephrectomy in the treatment for renal cell carcinoma (RCC) remains con troversial. With nephron-sparing surgery being commonly applied, the indica tion for adrenalectomy has to be critically assessed. Patients and Methods: In a retrospective analysis the outcome of 589 patients, who underwent ips ilateral adrenalectomy along with radical nephrectomy in the treatment for RCC between 1985 and 1997 at our institution, was evaluated. The mean follo w-up time was 34 months (range 1-95). Results: Histologically an ipsilatera l adrenal metastasis was found in 19/589 patients (3.2%). 16119 patients ha d greater than or equal to T3, 3/19 had T1 tumours. The average size of the primary tumours with adrenal metastasis was 7.8 cm (range 2.3-13) in diame ter with no preferential primary tumour site within the kidney (6/19 upper, 4/19 middle and 9/19 lower third). Only 4/19 patients had suspect adrenal findings in preoperative diagnostics (ultrasound, CT scan). 6/19 (31.5%) pa tients with adrenal metastasis are alive without evidence of disease at a m ean of 41 months (range 11-95) after surgery for RCC. Conclusions: The prob ability of adrenal metastasis correlates with primary tumour stage, but not with its location within the kidney. The preoperative diagnostics are not reliable concerning small adrenal metastases. We thus still recommend simul taneous adrenalectomy in those cases where radical nephrectomy in patients with RCC is indicated.