Incidence and outcome of patients with adrenal metastases of renal cell cancer

Objectives. To evaluate the outcome of patients with adrenal metastasis in renal tumors to establish the oncologic necessity of adrenalectomy in these patients. Radical nephrectomy for renal cell cancer includes simultaneous ipsilateral adrenalectomy. Recent reports suggest that adrenal involvement in renal cell cancer is rare and can be predicted by computed tomography or distinct algorithms. Methods. in a retrospective analysis of 866 consecutive patients who underw ent nephrectomy and adrenalectomy, we established the rate of adrenal metas tasis and obtained follow-up information to evaluate disease outcome. Results. We calculated an adrenal metastasis rate of 3.1% (n = 27); of thes e 27 patients, only 6 (0.7% of all patients) presented with a solitary adre nal metastasis. Kaplan-Meier analysis demonstrated that patients with solit ary adrenal and multiple metastases have a poor outcome. The median surviva l of patients with localized renal cancer was 43.9 months compared with 21. 3 months for patients with a solitary adrenal metastasis and 11.0 months fo r patients with multiple metastases, Conclusions. Ipsilateral, solitary, and synchronous metastases in renal cel l cancer are rare and patients have a poor outcome despite surgical resecti on. Therefore, simultaneous adrenalectomy can be omitted during radical nep hrectomy if the preoperative examinations or algorithms used do not predict adrenal metastasis in the patient with renal cell cancer. UROLOGY 57: 878- 882, 2001. (C) 2001, Elsevier Science Inc.