Routine Adrenalectomy in Patients with Locally Advanced Renal Cell Cancer Does Not Offer Oncologic Benefit and Places a Significant Portion of Patients at Risk for an Asynchronous Metastasis in a Solitary Adrenal Gland

BackgroundThe indications for the removal of the ipsilateral adrenal gland in patients with renal cell carcinoma (RCC) and the long-term outcomes have not been well studied.ObjectiveWe evaluated the risk of synchronous and asynchronous adrenal involvement in patients with RCC and the effect of adrenalectomy on recurrence and survival in a large, single-institution cohort.Design, setting, and participantsFrom 1970 to 2006, 4018 consecutive patients with RCC treated by surgical extirpation (radical nephrectomy [RN]: 3107; partial nephrectomy [PN]: 911) from Mayo Clinic were studied for adrenal involvement. Risk of asynchronous adrenal metastasis and cancer-specific survival (CSS) were also compared between those who underwent concomitant ipsilateral adrenalectomy (n = 1541) and those who did not (n = 2477) using multivariate Cox models.InterventionSurgical removal of the adrenal gland at the time of kidney tumor resection.MeasurementsPrimary outcome is cancer specific survival; secondary outcomes are incidence of synchronous and asynchronous adrenal metastases.Results and limitationsMedian postoperative follow-up among those still alive was 8.2 yr (interquartile range [IQR]: 5.3–13.6). Synchronous ipsilateral adrenal involvement was rare (n = 88; 2.2%). Ipsilateral adrenalectomy at the time of nephrectomy did not lower the risk of subsequent adrenal metastasis (hazard ratio [HR]: 0.96; 95% confidence interval [CI], 0.64–1.42) or improve CSS (HR: 1.08; 95% CI, 0.95–1.22). The development of asynchronous adrenal metastasis occurred in 147 patients (3.7%) at a median of 3.7 yr (IQR: 1.2–7.7) after initial surgery. The risk of developing an ipsilateral versus a contralateral asynchronous adrenal metastasis was equivalent at 10 yr in those who did not undergo adrenalectomy at initial surgery. This study is limited by its single-institution, nonrandomized nature.ConclusionsRoutine ipsilateral adrenalectomy in patients with high-risk features does not appear to offer any oncologic benefit while placing a significant portion of patients at risk for metastasis in a solitary adrenal gland. Therefore, adrenalectomy should only be performed with radiographic or intraoperative evidence of adrenal involvement.