The Adrenal Gland and Renal Cell Carcinoma: Is Ipsilateral Adrenalectomy a Necessary Component of Radical Nephrectomy?

The ipsilateral adrenal gland may be involved by renal cell carcinoma through direct invasion or embolic metastases, and usually it is removed as part of the radical nephrectomy specimen. We reviewed retrospectively 44 patients with stage A and 8 patients with stage B renal cell carcinoma, 25 of whom had undergone ipsilateral adrenalectomy. The 5-year and 9-year survival of these 25 patients was 79 and 65 per cent, respectively, and was not statistically different from the 78 per cent 5-year and 9-year survival of those 27 patients who did not undergo ipsilateral adrenalectomy. These findings suggest that the ipsilateral adrenal gland need not be removed routinely as part of perifascial nephrectomy for renal cell carcinoma. Those patients who are found to have a contralateral adrenal lesion during preoperative evaluation should be spared bilateral adrenalectomy if there is no ipsilateral adrenal gland involvement at exploration. Those patients with lower pole lesions also need not undergo routine ipsilateral adrenalectomy. Preoperative computerized tomography scans will help to select those tumors that can be managed by perifascial nephrectomy with sparing of the ipsilateral adrenal gland.