Can we spare removing the adrenal gland at radical nephrectomy in children with wilms tumor?
OBJECTIVE
In patients with Wilms tumor indications for adrenalectomy are not well-defined. Following the rationale for preserving the adrenal gland in cases of other renal malignancies we determined predictors of adrenal involvement and the impact of adrenalectomy on retroperitoneal recurrence.


METHODS
We retrospectively reviewed the record of patients who underwent surgical resection as primary treatment for Wilms tumor between 1990 and 2008 at 2 Canadian pediatric centers. Patient and tumor characteristics were reviewed to determine potential links to adrenal involvement. Recurrence was evaluated as a time dependent variable based on followup duration.


RESULTS
Of 180 patients diagnosed with Wilms tumor 95 underwent initial radical nephrectomy. Mean ± SD age at diagnosis was 46 ± 38 months and mean survival followup was 189 ± 8.3 months. Disease was stage 1 to 4 in 28, 34, 23 and 4 patients, respectively. Adrenalectomy was done in 58 patients (61%). Only 1 adrenal gland was reportedly positive for tumor invasion while peri-adrenal fat involvement was noted in 3 patients. No studied patient or tumor characteristics predicted involvement. No statistically significant difference in retroperitoneal recurrence was found between the groups in which the adrenal gland was removed vs preserved.


CONCLUSIONS
Adrenal involvement in patients with Wilms tumor is rare and difficult to predict. Preserving the adrenal gland was not associated with an increased risk of local recurrence. Thus, it seems prudent to avoid adrenalectomy at radical nephrectomy when technically feasible, instead attempting to otherwise remove all peri-adrenal fat with the specimen.
Moore
Katherine
K
Division of Urology, Hospital for Sick Children, University of Toronto, Ontario, Canada.
Leslie
Bruno
B
Salle
João L Pippi
JL
Braga
Luis H P
LH
Bägli
Darius J
DJ
Bolduc
Stéphane
S
Lorenzo
Armando J
AJ
D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009392:Nephrectomy; D012189:Retrospective Studies; D009396:Wilms Tumor / Q000473:pathology / Q000601:surgery*