Анализ ипсилатеральной адренальной патологии у пациентов с почечно-клеточным раком

Abstract

The purpose of the study was the analysis of the structure of the pathology of the ipsilateral adrenal gland after radical nephrectomy or partial nephrectomy in patients with renal cell cancer. Materials and methods. To study the structure of adrenal pathology in a sample of 2,084 patients who were treated for renal cell cancer, a retrospective study of the pathological findings and case reports of 108 patients, in whom surgical treatment included adrenalectomy or adrenal resection, was performed. Results and discussion. In 10 (83.3%) of 12 patients with adrenal gland resection, mass lesions of this organ served as an indication for adrenal surgery, while in 2 (16.7%) patients intraoperative adrenal trauma was noted. In this group, there were no situations of preservation of the adrenal gland with a direct generalization of the renal tumor to it. Among 98 patients who underwent adrenalectomy, the main indications for removal of the adrenal gland were its mass lesions in 65 (66.3%) cases, while direct tumor generalization to the ipsilateral adrenal gland took place in 8 (8.2%) cases. In other 7 (7.1%) situations, a tumor thrombus penetrated through the lumen of the renal or inferior vena cava into the lumen of the adrenal vein. In 16 (16.7%) patients, adrenalectomy was performed due to massive trauma to the adrenal gland during the removal of massive renal tumors localized in the upper pole of the kidney. Among all 75 patients with mass ipsilateral lesions of the adrenal glands, metastases of renal cell cancer were detected in 12 (16%) cases. In 59 (78.7%) cases benign adrenal adenomas were found, in 2 (2.7%) cases – myelolipomas, in 1 (1.3%) – adrenal hyperplasia, in another 1 (1.3%) – pheochromocytoma. The proportion of synchronous malignant pathology of the ipsilateral adrenal gland in patients with renal cell cancer and with indications for adrenalectomy was 25% (27 out of 108 observations). In relation to all 2,084 operated patients, this indicator did not exceed 1.3%. In the group of organ-preserving surgery, it was significantly lower – 0.2% (2 out of 968 patients), while in the group of radical or cytoreductive nephrectomy it reached 2.2% (25 out of 1116 cases). The total amount of cases of the ipsilateral adrenal gland lesions with renal cell cancer was also studied: 12 (0.6%) – metastases, 8 (0.4%) – direct tumor generalization and 7 (0.3%) – tumor invasion into the adrenal vein, which was determined in 27 (1.3%) patients. Conclusion. The need for ipsilateral adrenalectomy or adrenal resection is extremely rare in the large modern cohort of patients. At the same time, a significant part of the synchronous formations of the ipsilateral adrenal glands is benign tumors. In this regard, further study of the feasibility and safety of adrenal organ-preserving surgeries is necessary