title: Low incidence of ipsilateral adrenal involvement and recurrences in patients with renal cell carcinoma undergoing radical nephrectomy: a retrospective analysis of 393 patients.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Urology, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Eijiro
authors.initials: E
authors.lastname: Nakamura
authors.forename: Shingo
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kamoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okuno
authors.forename: Akito
authors.initials: A
authors.lastname: Terai
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kakehi
authors.forename: Toshiro
authors.initials: T
authors.lastname: Terachi
authors.forename: Keita
authors.initials: K
authors.lastname: Fujikawa
authors.forename: Shigeki
authors.initials: S
authors.lastname: Fukuzawa
authors.forename: Hideo
authors.initials: H
authors.lastname: Takeuchi
authors.forename: Osamu
authors.initials: O
authors.lastname: Ogawa
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000556:secondary* / Q000601:surgery; D000315:Adrenalectomy; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000556:secondary* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009392:Nephrectomy; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome