title: Routine adrenalectomy is unnecessary during surgery for large and/or upper pole renal tumors when the adrenal gland is radiographically normal.
abstract: OBJECTIVE
  Concurrent adrenalectomy during renal surgery for renal cell carcinoma was once routine. More recent data suggest that adrenalectomy should be reserved for tumors 7 cm or greater, particularly those involving the upper pole. We evaluated the radiographic and pathological incidence of adrenal involvement in patients undergoing renal surgery for renal cell carcinoma 7 cm or greater.
  
  
  METHODS
  Patients who underwent renal surgery for tumors 7 cm or greater between 1999 and 2008 were identified from our kidney cancer registry. We used Fisher's exact test to determine whether radiographic tumor site predicted adrenal involvement. The Kaplan-Meier method and Cox proportional hazard regression models were used to analyze the impact of adrenal resection on outcome.
  
  
  RESULTS
  Of 1,650 patients we identified 179 patients who underwent surgery for renal cell carcinoma 7 cm or greater. Of these patients 91 underwent concurrent total ipsilateral adrenalectomy at renal surgery with pathological adrenal involvement confirmed in 4 (4.4%). Upper pole site did not predict involvement (p = 0.83). Preoperative adrenal imaging was 100% sensitive and 92% specific to detect adrenal involvement by renal cell carcinoma with 100% negative predictive value. No survival advantage was noted on multivariate analysis when comparing patients who underwent adrenal resection to 88 in whom the adrenal gland was spared (p = 0.38).
  
  
  CONCLUSIONS
  Synchronous ipsilateral adrenal involvement with renal cell carcinoma is rare even in cases of large and/or upper pole tumors, making routine adrenalectomy unnecessary. Preoperative adrenal imaging is highly sensitive and should inform the decision to perform adrenalectomy more than tumor size or site.
authors.affiliation: Department of Urological Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kutikov
authors.forename: Zachary J
authors.initials: ZJ
authors.lastname: Piotrowski
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Canter
authors.forename: Tianyu
authors.initials: T
authors.lastname: Li
authors.forename: David Y T
authors.initials: DY
authors.lastname: Chen
authors.forename: Rosalia
authors.initials: R
authors.lastname: Viterbo
authors.forename: Richard E
authors.initials: RE
authors.lastname: Greenberg
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Boorjian
authors.forename: Robert G
authors.initials: RG
authors.lastname: Uzzo
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery; D000311:Adrenal Glands / Q000000981:diagnostic imaging*; D000315:Adrenalectomy / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000601:surgery; D011859:Radiography; D012016:Reference Values; D012189:Retrospective Studies; D019564:Unnecessary Procedures; D055815:Young Adult