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The Necessity of Adrenalectomy at the Time of Radical Nephrectomy: A Systematic Review

The Necessity of Adrenalectomy at the Time of Radical Nephrectomy: A Systematic Review,10.1016/j.juro.2009.01.018,Journal of Urology,Rebecca L. O'Mall

The Necessity of Adrenalectomy at the Time of Radical Nephrectomy: A Systematic Review   (Citations: 10)
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Purpose: We describe the literature base pertaining to adrenalectomy at radical nephrectomy and present a pragmatic approach based on primary tumor and disease characteristics. Materials and Methods: Literature searches were performed via the National Center for Biotechnology Information databases using various keywords. Articles that pertained to the concomitant use of adrenalectomy with radical nephrectomy were surveyed. Results: The incidence of solitary, synchronous, ipsilateral adrenal involve- ment, ie that which is potentially curable with ipsilateral adrenalectomy along with nephrectomy, is much lower than previously thought at 1% to 5%. Evidence to date supports increased size and T stage, multifocality, upper pole location and venous thrombosis as risk factors for adrenal involvement. Cross- sectional imaging is now accurate at demonstrating the absence of adrenal involvement but still carries a significant risk of false-positives. The morbidity of adrenalectomy is minimal except in those patients with metachronous contralateral adrenal metastasis in whom the impact of adrenal insufficiency can be devastating. Disease specific and overall survival of those undergoing radical nephrectomy, with or without adrenalectomy, are similar. The sur- vival of patients with widespread metastatic disease is historically poor re- gardless of whether adrenalectomy is performed. There is evidence for a survival advantage in patients with isolated adrenal metastasis, although this group comprises no more than 2% of those undergoing surgery for renal tumors. Conclusions: The apparent benefit of ipsilateral adrenalectomy does not support it as a standard practice in all patients with normal imaging. However, it should be considered in select cases in which there are risk factors for adrenal involvement.
Journal: Journal of Urology - J UROL , vol. 181, no. 5, pp. 2009-2017, 2009
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    • ... In their analysis of 27 studies, O'Malley and colleague...

    Michael J. Leveridgeet al. Imaging renal cell carcinoma with ultrasonography, CT and MRI

    • ...Background Metastases to the adrenal gland are the second most common type of adrenal mass lesion after adrenocortical adenomas [1, 2]. However, less than 2% of those patients who develop a metachronous metastasis after resection of a primary renal tumour will present with a solitary adrenal tumour [3]...
    • ...Radical nephrectomy includes resection of the adjacent adrenal gland, but ipsilateral adrenalectomy is no longer routinely performed [2]...
    • ...Although cross-sectional imaging can now accurately determine adrenal involvement, it is still associated with a risk of false positives [2]...
    • ...Until relatively recently, adrenalectomy was generally recommended along with nephrectomy because of the possibility of direct lymphatic and haematogenous spread and the high reported incidence of adrenal involvement in early radical nephrectomy series [2]...
    • ...They advised that routine adrenalectomy should be considered when cross-sectional imaging suggests an isolated adrenal metastasis, if there is involvement of the adrenal vein or if the tumour is greater than 7 cm in diameter and localised to the upper pole [2]...

    D. McGroganet al. Laparoscopic adrenalectomy for a late solitary renal cell cancer metas...

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