The Clinical Significance Of Adrenalectomy At The Time Of Radical Nephrectomy

Objective:With the increasing use of imageological examination and the healthcare management,more and more incidental renal cell carcinomas have been diagnosed.Thus,the rate of localized renal cell carcinoma is significantly increasing.In radical nephrectomy,whether adrenalectomy should be performed remains controversial.In this retrospective study,the patients who had undergone radical nephrectomy for renal cell carcinoma at Chifeng Municipal Hospital were follow-up,with the aim of discussing clinical significance of adrenalectomy at the time of radical nephrectomy.Methods:386 patients who had undergone radical nephrectomy for renal cell carcinoma from Jan.2012 to Dec.2018 were retrospectively reviewed.The clinical and pathological data were collected.In the 386 cases,84 underwent radical nephrectomy and ipsilateral adrenalectomy,whereas adrenal glands were reserved in 302 cases.The Kaplan-Meier method was used to analyze the significantly difference of long-term survival rate between who did or did not undergo concomitant ipsilateral adrenalectomy.Results:Overall,110 out of the 386 patients(28.5%)had tumors at upper pole of the kidney.84 of them underwent ipsilateral adrenalectomy during radical nephrectomy,whereas adrenal conservation surgery were done in 26.By Kapplan-Meier evaluation,the survival rates of patients who did or did not undergo concomitant ipsilateral adrenalectomy was 85%and 86%,respectively,the difference was not statistically significant(p=0.779).Of the 84 patients underwent adrenalectomy,70 were without evidence of abnormality either by imaging examination or by intra-operative checkup.None of them was found to have evidence of metastasis during pathological study(0%),while only 3 patients were detected to have benign disease of adrenal gland(4.3%).Nine were with the evidence of abnormality both by imaging examination and by intra-operative checkup,including 2 with adrenal metastasis,6 with benign disease of adrenal gland and 1 normal adrenal gland.3 were with the evidence of abnormality by imaging examination,all of them were normal.2 were with the evidence of abnormality by intra-operative checkup,including lwith benign disease of adrenal gland and 1 normal adrenal gland.Conclusions:With these data available,we are now aware that there is no significantly difference of long-term survival rate between who did or did not undergo concomitant ipsilateral adrenalectomy with an upper pole tumor in radical nephrectomy.We recommend that adrenalectomy should only be performed if radiographic evidence reveals metastasis in the adrenal gland or if gross disease of adrenal gland is present at the time of nephrectomy,but the accurate results need further research.