NEW YORK (Reuters Health) – Adrenal involvement is rare in cases of renal cell carcinoma, even when the tumor is large or in the upper pole. Therefore, concurrent adrenalectomy is not usually necessary, researchers report.

Writing in the April issue of the Journal of Urology, Dr. Robert G. Uzzo and colleagues at the Fox Chase Cancer Center in Philadelphia, Pennsylvania, note that concurrent adrenalectomy during surgery for renal cell carcinoma was once routine. More recently, however, evidence has indicated that adrenalectomy should be reserved for large tumors, especially those located in the upper pole.

As the authors point out, “Adrenalectomy may give rise to challenging clinical circumstances in which patients may be subject to lifelong adrenal insufficiency, a condition that significantly impacts quality of life and possibly life expectancy.”

To look into this issue further, the team evaluated adrenal involvement in 179 patients in the center’s kidney cancer registry who had surgery for renal tumors 7 cm in size or larger. In this group, 91 underwent concurrent adrenalectomy at renal surgery.

The investigators report that pathological adrenal involvement was confirmed in only 4 of the 91 (4.4%). Furthermore, preoperative adrenal imaging had 100% sensitivity and 92% specificity in detecting adrenal involvement, with 100% negative predictive value.

Upper pole location did not predict adrenal involvement, and there was no survival advantage among the patients who underwent adrenalectomy compared to those who did not, whether the disease was localized or had metastasized.

“Routine adrenalectomy even in patients with large and/or upper pole renal tumors does not appear to be required,” Dr. Uzzo and colleagues conclude. “Modern radiographic imaging is extremely sensitive to detect adrenal pathology and should guide management decisions regarding the need for concurrent adrenalectomy.”

Reference:

Routine Adrenalectomy Is Unnecessary During Surgery for Large and/or Upper Pole Renal Tumors When the Adrenal Gland Is Radiographically Normal

J Urol 2011;195:1198-1203.