Objectives: To evaluate, in a retrospective analysis of the outcome of 393 consecutive patients undergoing radical nephrectomy, the advantages and disadvantages of concomitant ipsilateral adrenalectomy with this operation.
Methods: The medical records, pathologic specimens, and preoperative and postoperative computed tomography scans of 165 patients with, and 228 patients without, concomitant adrenalectomy were reviewed. The incidence of adrenal involvement in the former patients and ipsilateral adrenal recurrence in the latter patients was evaluated. The influence of adrenalectomy on the disease-specific survival was also assessed by both univariate and multivariate analyses.
Results: Of the 165 patients, only 5 (3.0%) had adrenal involvement. All of these cases were diagnosed as cT3 or greater preoperatively, and preoperative computed tomography detected 4 of these 5 cases. Of the 228 patients without adrenalectomy, no ipsilateral adrenal recurrence was observed at a mean follow-up of 65.2 months. Ipsilateral adrenalectomy did not confer a favorable prognosis on the patients.
Conclusions: Our results indicate that the advantages of ipsilateral adrenalectomy in patients with normal findings on preoperative computed tomography are limited. Concomitant ipsilateral adrenalectomy is indicated in cases such as locally advanced tumors with uncertain preoperative imaging studies or those with apparent adhesion or inflammation around the adrenal gland at surgery, thus suggesting perinephric tumor involvement.