To characterize proportion of patients receiving adrenalectomy, adrenal involvement prevalence and oncologic outcomes of routine adrenalectomy in contemporary practice. Ipsilateral adrenalectomy was once standard during radical nephrectomy. However, benefit of routine adrenalectomy has been questioned because adrenal involvement of renal cell carcinoma (RCC) is low.
All patients receiving radical nephrectomy in the Canadian Kidney Cancer information system (CKCis), a collaborative prospective cohort populated by 14 major Canadian centers, between January 2011 to February 2020 were included. Patients were excluded if they had non-RCC histology, multiple tumors, contralateral tumors, metastatic disease or previous history of RCC. Patient demographic, clinical, and surgical information were summarized and compared. Cox-proportional hazards was used for multivariable analysis.
During study period, 2759 patients received radical nephrectomy, of these, 831(30.1%) had concomitant adrenalectomy. Pathological adrenal involvement was identified in 102 (3.7%overall; 12.3%of adrenalectomy). Median follow-up was 21.6months (Interquartile range 7.0-46.5). Patients with adrenalectomy had higher venous tumor thrombus (30.3% vs. 9.6%; p<0.0001), higher T stage (71.1% vs. 43.4% pT3/4; p<0.0001), lymph node metastases (17.6% vs. 10.7%; p=0.0035), Fuhrman grades (71.4% of Fuhrman grades 3/4 vs. 56.2%; p<0.0001) and increased proportion of clear cell histology (79.3% vs. 74.5%; p=0.0074) compared to the no adrenalectomy group. Adrenalectomy patients had higher risk of recurrence (HR 1.23; 95%CI 1.04-1.47; P=0.019) and no difference in survival (HR 1.09, 95% CI 0.86-1.38, p=0.48).
Adrenalectomy is not associated with better oncological outcome of recurrence/survival. Adrenalectomy should be reserved for patients with radiographic adrenal involvement and/or intra-operative adrenal involvement.
Urology. 2021 Jun 12 [Epub ahead of print]
Arnon Lavi, Rodney H Breau, Ranjeeta Mallick, Anil Kapoor, Antonio Finelli, Alan So, Frédéric Pouliot, Simon Tanguay, Luke T Lavallée, Ricardo Rendon, Adrian Fairey, Darrel E Drachenberg, Jean-Baptiste Lattouf, Ranjena Maloni, Nicholas E Power
Urology Division, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada., The Division of Urology, The Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, ON, Canada., School of Epidemiology and Public Health, University of Ottawa, ON, Canada., McMaster Institute of Urology, at St. Joseph's Healthcare, Hamilton, ON, Canada., Division of Urologic Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada., Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada., Department of Surgery, Division of Urology, Université Laval, Quebec City, QC, Canada., Department of Urology, McGill University Health Centre, Montreal, Quebec, Canada., Department of Urology, QEII Health Sciences Centre, Dalhousie University, Halifax, NS; Canada., Division of Urology, University of Alberta, Edmonton, Alberta, Canada., Division of Urology, University of Manitoba, Winnipeg, MB, Canada., Division of Urology, University of Montreal Hospital Centre (CHUM), Montreal, QC, Canada., Urology Division, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Electronic address: .