Adrenalectomy in cases of tumor nephrectomy - An overtreatment?

Metastatic spread to the ipsilateral adrenal gland occurs in 1.2-10% of pat ients with renal cell carcinoma (RCC). In the majority of these cases, the primary tumor is locally advanced with poor differentiation, venous invasio n, and involvement of the regional lymph nodes. Adrenal metastases are usua lly detected preoperatively by CT scan or MRI. Adrenal metastases are indicators of system ic disease with poor prognosis quo ad vitam. Only 0.5-2.3% of patients with RCC and adrenal metastases are free of Venous invasion or lymphatic disease. In this small subset of pati ents, cure is possible by surgical removal of the adrenal gland. In 97.7-99 .5% of patients with RCC, ipsilateral adrenalectomy has no impact on their prognosis. We therefore conclude that this procedure should be performed on ly if there is radiological suspicion of an adrenal mass.