title: Incidence of synchronous and metachronous adrenal metastases following tumor nephrectomy in renal cell cancer patients: a retrospective bi-center analysis.
abstract: BACKGROUND
  Synchronous adrenalectomy has become dispensable since retrospective studies have demonstrated no survival benefit when preoperative imaging was normal. The aim of this large bi-institutional study was to determine the appearance of synchronous and metachronous metastases to the adrenal gland as detected by computed tomography and positron emission tomography or magnetic resonance imaging with consecutive surgical removal of suspicious lesions.
  
  
  METHODS
  We retrospectively reviewed the clinico-pathological records of 2720 patients from two urological centers who underwent radical or partial nephrectomy due to kidney cancer disease. Synchronous adrenalectomy was carried out in 548 of all cases (20.2%). Metachronous adrenalectomy was performed in 24 cases due to suspicious imaging in follow-up.
  
  
  RESULTS
  Metastatic spread in patients with synchronous adrenalectomy was found in 29/548 cases (5.3%), as suspected. In metachronous procedures positive pathological results were found in 24 of 24 cases. Among them 54% of all tumor recurrences were detected in the contralateral adrenal gland.
  
  
  CONCLUSIONS
  In case of preoperative suspicious imaging an intraoperative frozen section should be performed. Radiological investigations are of high diagnostic value for detecting metachronous tumor growth into the adrenal gland. Surgery in this scenario should be recommended due to the high malignancy rate reported here.
authors.affiliation: Dept. of Urology and Urologic Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
authors.forename: Inga
authors.initials: I
authors.lastname: Peters
authors.forename: Milan
authors.initials: M
authors.lastname: Hora
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Herrmann
authors.forename: Christoph
authors.initials: C
authors.lastname: von Klot
authors.forename: Gerd
authors.initials: G
authors.lastname: Wegener
authors.forename: Petr
authors.initials: P
authors.lastname: Stransky
authors.forename: Ondrej
authors.initials: O
authors.lastname: Hes
authors.forename: Markus A
authors.initials: MA
authors.lastname: Kuczyk
authors.forename: Axel S
authors.initials: AS
authors.lastname: Merseburger
keywords: Adrenal gland; Laparoscopy; Metachronous metastasis; Renal cell carcinoma; Synchronous metastasis