Simultaneous Adrenalectomy During Radical Nephrectomy for Renal Cell Carcinoma Will Not Cure Patients With Adrenal Metastasis

ObjectivesTo present data from all patients with adrenal involvement after prolonged follow-up and to revise our advice given in 1999. In 1999, we published our results for a large series of patients with adrenal metastasis from renal cell carcinoma.MethodsThe charts of 617 patients who had undergone radical nephrectomy with simultaneous adrenalectomy for renal cell carcinoma at the Department of Urology, Philipps-University Medical School, Marburg from 1985 to 1999 were retrospectively reviewed. In 1999, 23 of 617 patients (3.7%) were found to have adrenal metastasis. The 23 patients included 16 with unilateral ipsilateral adrenal metastasis only, 1 with unilateral contralateral metastasis, and 6 with bilateral adrenal involvement. The postoperative course of the 23 patients has been updated regarding progression and survival after surgery.ResultsAfter a mean follow-up of 59.1 months (range 1.1-156.7), only 5 patients were still alive, all with progressive disease. With a mean interval to death of 41.7 months (range 1.1-126.0), 18 patients had died, 17 of whom had cancer progression. One patient died without signs of disease recurrence 49.1 months after radical nephrectomy and simultaneous ipsilateral adrenalectomy. The mean time to progression was 34.2 months (range 0-91.5).ConclusionsWith these data available, we are now aware that we cannot cure patients with adrenal metastasis by incorporating simultaneous ipsilateral adrenalectomy into routine radical nephrectomy for renal cell carcinoma. The routine incorporation of ipsilateral adrenalectomy should, therefore, be abandoned.