Adrenal sparing surgery during radical nephrectomy in patients with renal cell cancer: A new algorithm

Purpose: Ipsilateral adrenalectomy is usually performed during radical neph rectomy because of renal cell cancer. Because renal tumors are detected mor e often in the earlier stages due to widespread use of ultrasound and compu terized tomography, we define a subset of patients who would be eligible fo r adrenal sparing surgery. In a retrospective analysis we evaluated whether parameters obtained preoperatively are able to predict adrenal metastasis. Materials and Methods: A total of 866 consecutive patients who underwent ne phrectomy and ipsilateral adrenalectomy from 1983 to 1999 were evaluated. P reoperative parameters, including tumor size, location, clinical stage, num ber of tumors, and patient age and sex, were retrospectively compared with the histological results. Univariate and multivariate analyses were perform ed. Results: A total of 27 (3.1%) adrenal metastases were noted in the 866 pati ents, and 63% were on the left side and 37% on the right side. Mean tumor s ize was 10 cm. with versus 6 cm. without adrenal involvement. Of the 27 pat ients 21 had multiple metastases at diagnosis and only 6 (0.7% of all 866) presented with solitary ipsilateral adrenal metastasis. Univariate and mult ivariate analyses revealed tumor size and M stage as best preoperative pred ictors of adrenal involvement. Conclusions: Adrenal sparing surgery is possible, and we suggest a new algo rithm. If maximum tumor size measured by computerized tomography is less th an 8 cm. and staging examination does not show organ or lymph node metastas es, adrenalectomy is not necessary because of oncological reasons. This alg orithm has to be validated by a prospective analysis.