You have accessJournal of UrologyAdrenal: Surgery + Tumors/Benign and Malignant Disease (Physiology and Pharmacology)1 Apr 201251 ADRENAL INVOLVEMENT IN RENAL CELL CARCINOMA: AVOIDING UNNECESSARY ADRENALECTOMY Stephen Blakely, Osama Zaytoun, Michael Daugherty, Steve Landas, Gennady Bratslavsky, and Oleg Shapiro Stephen BlakelyStephen Blakely Syracuse, NY More articles by this author , Osama ZaytounOsama Zaytoun Syracuse, NY More articles by this author , Michael DaughertyMichael Daugherty Syracuse, NY More articles by this author , Steve LandasSteve Landas Syracuse, NY More articles by this author , Gennady BratslavskyGennady Bratslavsky Syracuse, NY More articles by this author , and Oleg ShapiroOleg Shapiro Syracuse, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.095AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite the relatively low incidence of adrenal involvement in patients with renal cell carcinoma, routine adrenalectomy is still a commonly performed procedure during radical nephrectomy. We aimed to assess the frequency of adrenal involvement, the reliability of preoperative imaging to predict adrenal involvement, and the rate of unnecessary adrenalectomy performed during radical nephrectomy in patients treated for cortical renal masses at a single institution. METHODS After exclusion of patients who were treated with partial nephrectomy and those treated for TCC we identified 291 radical nephrectomies performed at a single academic center over the past 20 years. We only included those cases where pathology report specifically described the presence of adrenal gland in the specimen and the status of its involvement by carcinoma. In total, 123 patients with pathologically documented ipsilateral adrenalectomy were identified. Patient demographics, tumor characteristics, and available imaging studies were reviewed. RESULTS Of 123 patients with documented ipsilateral adrenalectomy, 6 (4.8%) were identified as having adrenal involvement. The average age of the patient was 60.6 years (26-85) and the average tumor size was 6.92 cm (2.3-20 cm). The mean tumor size in patients without adrenal involvement was 6.79 cm, while the mean tumor size in those with adrenal involvement was 9.62 cm (6.7-14 cm), p=0.68 (Student’s t-test). Four of 6 patients with adrenal involvement had imaging studies available for review and all 4 demonstrated suspicion for adrenal involvement preoperatively. Among 117 patients without adrenal involvement 35 (30%) had imaging available for review; 5 (14 %) demonstrated suspicion for adrenal involvement. Thus, the negative predictive value was 100% while the sensitivity and specificity were 100% and 95.9%, respectively. CONCLUSIONS Ipsilateral adrenal involvement in RCC is uncommon and reliably predicted by preoperative cross-sectional imaging. Among all adrenalectomies in this series, over 95% were performed unnecessarily. With careful review, preoperative imaging can help avoid unnecessary adrenalectomy during radical nephrectomy in patients with renal cortical tumors. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e22 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stephen Blakely Syracuse, NY More articles by this author Osama Zaytoun Syracuse, NY More articles by this author Michael Daugherty Syracuse, NY More articles by this author Steve Landas Syracuse, NY More articles by this author Gennady Bratslavsky Syracuse, NY More articles by this author Oleg Shapiro Syracuse, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...