Incidence of syn- and metachronous adrenal metastasis following tumor nephrectomy: A retrospective bicenter analysis.

Abstract

417 Background: Metastases of adrenal gland occur in approximately 1.2 - 10% in kidney cancer patients. Synchronous adrenalectomy has become dispensable since studies have demonstrated no clinical benefit. The aim of this large bi-institutional study was to determine the appearance of syn- and metachronous metastasis to the adrenal gland as detected by CT, PET-CT or MRI imaging with consecutively surgically removal of suspicious lesions. Methods: We retrospectively reviewed the clinical and pathological records of 2308 patients (1200 pts. from Medical School Hanover until 2009 and 1108 pts. from University Hospital Plzeň until 2010) who underwent radical/partial nephrectomy. Synchronous adrenalectomy was carried out in 222 of all cases (10.4%). Metachronous adrenalectomy was performed in 11 cases including 8 ipsilateral and 3 contralateral adrenalectomies due to suspicious imaging among follow-up. In cases of metachronous metastasis pre-operative imaging, surgical and histopathological results were correlated. Results: Metastatic spread in patients with synchronous adrenalectomy was found in 17/222 cases (7.6%), as suspected. In metachronous procedures positive pathological results was found in 10 of 11 (91%) cases. In one case it was a benign pathological result. In all positive cases a metastasis from the former clear cell carcinoma was pathologically confirmed. 27% of all cases were detected in the contralateral adrenal gland. Conclusions: Synchronous adrenalectomy is not routinely recommended with nephrectomy. In case of preoperative suspicious imaging an intraoperative frozen section should be performed. Radiological investigations are of high diagnostic value for detecting metachronous tumor growth within the adrenal gland. Surgery in this scenario should be recommended due to the here reported malignancy rate of 91%.