title: Contralateral adrenal metastasis of renal cell carcinoma: treatment, outcome and a review.
abstract: OBJECTIVE
  To report the surgical treatment of patients with renal cell carcinoma (RCC) metastatic to the contralateral adrenal gland and compare our experience with previous reports, as such metastases are found in 2.5% of patients with metastatic RCC at autopsy, and the role of resecting metastatic RCC at this site is not well defined.
  
  
  METHODS
  We retrospectively identified 11 patients who had surgery for metastatic RCC to the contralateral adrenal gland between October 1978 and April 2001. The patients' medical records were reviewed for clinical, surgical and pathological features, and the patients' outcome.
  
  
  RESULTS
  The mean (median, range) age of the patients at primary nephrectomy was 60.9 (64, 43-79) years; all had clear cell (conventional) RCC. Synchronous contralateral adrenal metastasis occurred in two patients. The mean (median, range) time to contralateral adrenal metastasis after primary nephrectomy for the remaining nine patients was 5.2 (6.1, 0.8-9.2) years. All patients were treated with adrenalectomy; there were no perioperative complications or mortality. Seven patients died from RCC at a mean (median, range) of 3.9 (3.7, 0.2-10) years after adrenalectomy for contralateral adrenal metastasis; one died from other causes at 3.4 years, one from an unknown cause at 1.7 years and two were still alive at the last follow-up.
  
  
  CONCLUSIONS
  The surgical resection of contralateral adrenal metastasis from RCC is safe; although most patients died from RCC, survival may be prolonged in individual patients. Hence, in the era of cytoreductive surgery, the removal of solitary contralateral adrenal metastasis seems to be indicated.
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: W K
authors.initials: WK
authors.lastname: Lau
authors.forename: H
authors.initials: H
authors.lastname: Zincke
authors.forename: C M
authors.initials: CM
authors.lastname: Lohse
authors.forename: J C
authors.initials: JC
authors.lastname: Cheville
authors.forename: A L
authors.initials: AL
authors.lastname: Weaver
authors.forename: M L
authors.initials: ML
authors.lastname: Blute
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000556:secondary* / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome