Leibovitch I, Raviv G, Mor Y, Nativ O, Goldwasser B
Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Urology. 1995 Sep;46(3):316-20. doi: 10.1016/S0090-4295(99)80213-1.
Ipsilateral adrenalectomy is traditionally advocated as part of radical nephrectomy performed for renal cell carcinoma. The current study addresses the controversy of whether ipsilateral adrenalectomy should be performed routinely during radical nephrectomy.
A total of 225 patients were treated surgically for renal cell carcinoma over an 18-year period. Of these patients, 158 underwent nephrectomy and simultaneous ipsilateral adrenalectomy and the other 67 had sparing of the ipsilateral adrenal gland. A retrospective analysis of the medical records and assessment of the clinical and the pathologic data were performed. Rates of survival and progression were evaluated in a subgroup of 109 patients, further subdivided into 54 patients who underwent concomitant adrenalectomy and 55 patients with the ipsilateral adrenal preserved during surgery.
Histopathologic abnormalities were detected in seven adrenal specimens (4.4%); however, only 3 patients (1.9%) had involvement of the adrenal by renal cell carcinoma. All cases of adrenal involvement were detected by the preoperative imaging modalities. Ipsilateral adrenalectomy did not improve the outcome in comparison to adrenal preservation.
In view of the rarity of ipsilateral adrenal metastasis, the questionable prognostic merits of concomitant adrenalectomy, and the availability of accurate imaging modalities, we conclude that ipsilateral adrenalectomy is not necessary in the majority of the patients undergoing radical nephrectomy for renal cell carcinoma.
同侧肾上腺切除术传统上被视为肾细胞癌根治性肾切除术的一部分。本研究探讨了在根治性肾切除术中是否应常规进行同侧肾上腺切除术这一争议问题。
在18年期间，共有225例患者接受了肾细胞癌手术治疗。其中，158例患者接受了肾切除术并同时进行了同侧肾上腺切除术，另外67例患者保留了同侧肾上腺。对病历进行回顾性分析，并对临床和病理数据进行评估。在109例患者的亚组中评估了生存率和疾病进展情况，该亚组进一步分为54例接受同期肾上腺切除术的患者和55例手术中保留同侧肾上腺的患者。
在7个肾上腺标本中检测到组织病理学异常（4.4%）；然而，只有3例患者（1.9%）的肾上腺受到肾细胞癌侵犯。所有肾上腺受累病例均通过术前影像学检查发现。与保留肾上腺相比，同侧肾上腺切除术并未改善预后。
鉴于同侧肾上腺转移罕见、同期肾上腺切除术的预后价值存疑以及准确影像学检查方法的可用性，我们得出结论，对于大多数接受肾细胞癌根治性肾切除术的患者，同侧肾上腺切除术并非必要。
