The Role of Adrenalectomy in Renal Cancer

Christopher J Weight; Peter F Mulders; Allan J Pantuck; R Houston Thompson

doi:10.1016/j.euf.2015.09.005

The Role of Adrenalectomy in Renal Cancer

Eur Urol Focus. 2016 Feb;1(3):251-257. doi: 10.1016/j.euf.2015.09.005. Epub 2015 Oct 3.

Authors

Christopher J Weight¹, Peter F Mulders², Allan J Pantuck³, R Houston Thompson⁴

Affiliations

¹ Department of Urology, University of Minnesota, Minneapolis, MN, USA. Electronic address: cjweight@umn.edu.
² Radbount University, Nijmegen Medical Centre, Nijmegen, The Netherlands.
³ University of California at Los Angles, Los Angeles, CA, USA.
⁴ Mayo Clinic, Rochester, MN, USA.

PMID: 28723393
DOI: 10.1016/j.euf.2015.09.005

Abstract

Context: Since the 1960s, routine ipsilateral adrenalectomy (IA) has been considered an integral step in the removal of renal tumors as a part of a radical nephrectomy. However, recent data from the past decade have narrowed the indications for adrenalectomy and called into question the need for adrenalectomy at all in the treatment of renal cell carcinoma (RCC).

Objective: We sought to identify the role of adrenalectomy in the treatment of RCC. Specifically, we wanted to answer the following questions: What is the incidence of ipsilateral adrenal involvement by cancer? How reliable is preoperative imaging? What is the rate of ipsilateral and contralateral metachronous recurrence? And finally, what are the potential noncancer sequelae from unnecessary removal of the adrenal gland?

Evidence acquisition: A systematic literature search of Embase, PubMed, Cochrane, and Ovid Medline was performed to identify studies evaluating the role of adrenalectomy during RCC surgery. Only articles published in English from the years 2000-2015 were included. Case reports, articles about primary adrenal tumors, letters to the editor, and surgical technique papers were excluded.

Evidence synthesis: We found little evidence to suggest that routine IA is associated with a higher risk of short-term surgical or medical complications. We did not find evidence that IA is associated with improved cancer control. Tomographic preoperative imaging of the adrenal gland demonstrating no cancer involvement is rarely wrong (<1% of the time), and the few adrenal lesions missed on imaging can often be identified intraoperatively. Some evidence indicates that IA may be associated with worse long-term survival. Adrenalectomy rates have been decreasing in recent years, reflecting a changing practice pattern.

Conclusions: IA at the time of kidney surgery for a renal mass should be performed only if radiographic or intraoperative evidence indicates adrenal gland involvement.

Patient summary: We sought to define the role of adrenalectomy in patients with kidney cancer. Although there are not high-quality studies to answer this question definitively, we conclude that the adrenal gland should be spared unless there is clinical evidence of adrenal involvement.

Keywords: Adrenalectomy; Kidney cancer; Radical nephrectomy; Renal cell cancer.

Publication types

Review