Ces Urol 2002, 6(1):4-7 | DOI: 10.48095/cccu2002001

When it is necessary to perform adrenalectomy in radical nephrectomy and when it is not?

R. Fiala, L. Domes, K. Belej, F. Záťura

Urologická klinika, Fakultní nemocnice, Olomouc Urologické oddělení, Nemocnice Kroměříž

Adrenalectomy is indivisible part of radical nephrectomy since 1963. The question: Is it necessary to perforn adrenalectomy in radical neprectomy? is dicussed more intensively during past 10 years.
Data of patients with renal adenocarcinoma treated in The Department of Urology, University Hospital Olomouc and Urological Ward, Hospital Kroměříž were evaluated retrospectively. Complete documentation was available in 348 patients. Radical nephrectomy with adrenalectomy was performed in 90 cases and in 2 58 cases was performed radical nephrectomy without adrenalectomy.
Upper renal pole was affected in 134 patients (38,5 %), central part of kidney was affected in 74 cases (21,2 %), lower renal pole in 121 patients (34,8 %) and entire kidney in 19 patients (5,5 %) in both groups.
In adrenalectomy group adrenal gland was infiltrated in 4 cases, ipsilateral metastasis was found in 1 case and there were no synchronous contralateral metas-tases. Median survival rate for patients with kidney involvement only was 152 months (range 12 -175 months) for pT1, 110 months (range 6 - 204 moths) for pT2 and 89 months (range 8-135 months) for pT3 (graphs 1,2,3). pT4 was not evaluated becauce of low number of patients. Median survival rate for patients with also adrenal gland involvement was 56 months (range 7 - 100 months).
Low incidence of adrenal gland involvement makes adrenalectomy unnecessary in 90% of cases. In these cases is possible to detect adrenal gland involvement by CT scan and in dubiousness cases is possible to differ benign and malignant process in adrenal gland by MRI scan. It is not necessary to perform adrenalectomy if adrenal gland involvement has not been confirmed peroperatively. On the contrary, when CT or MRI scans are positive or adrenal gland involvement is suspected peroperatively adrenalectomy is indicated.

Keywords: Renal adenocarcinoma, Operative treatment, Adrenalectomy, Metastases

Published: January 1, 2002