title: Investigation on the indication of ipsilateral adrenalectomy in radical nephrectomy: a meta-analysis.
abstract: BACKGROUND
  With a trend that renal tumors are being detected at an earlier stage, classical radical nephrectomy is being reconsidered. More conservative techniques are being proposed. To clarify the indication for synchronous adrenalectomy in radical nephrectomy for renal cell carcinoma which has been questioned since the 1980s, this study evaluates the role of adrenalectomy and recommends a new indication for adrenalectomy in renal cell carcinoma.
  
  
  METHODS
  A systemic search was performed, using PubMed and Google Scholar, of all English language studies published up to March 2012 that compared adrenalectomy with adrenal-sparing surgery, in surgery for renal cell carcinoma. We assessed preoperative imaging for adrenal involvement and the relationship of tumor location with adrenal metastases. Twenty-one studies (20 retrospective and 1 prospective) involving 11 736 patients were included.
  
  
  RESULTS
  The mean incidence of ipsilateral adrenal involvement from renal cell carcinoma was 4.5%. Synchronous adrenalectomy did not alter survival (hazard ratio (HR) = 0.89, 95% confidence interval (CI) 0.67 - 1.19, P = 0.43; odds ratio (OR) = 1.10, 95%CI 0.84 - 1.44, P = 0.49). Upper pole tumors were not associated with a higher incidence of ipsilateral adrenal metastases. Pooled preoperative imaging: sensitivity, specificity, positive predictive value and negative predictive value were 92% (95%CI 0.84 - 0.97), 95% (95%CI 0.93 - 0.96), 71.6% and 98.5% respectively.
  
  
  CONCLUSIONS
  Adrenal involvement from renal cell carcinoma is rare, even in advanced tumours. Synchronous adrenalectomy does not offer any benefit, even for "high risk" patients. We suggest that only patients with a positive preoperative adrenal finding on preoperative imaging for a solitary adrenal metastasis should undergo adrenalectomy as part of the radical nephrectomy.
authors.affiliation: Department of Urology, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong 510120, China.
authors.forename: Jia-Rui
authors.initials: JR
authors.lastname: Su
authors.forename: Ding-Jun
authors.initials: DJ
authors.lastname: Zhu
authors.forename: Wu
authors.initials: W
authors.lastname: Liang
authors.forename: Wen-Lian
authors.initials: WL
authors.lastname: Xie
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000556:secondary / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods*; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods*; D015996:Survival Rate