Vol. 25, No. 4, 2003 (December)
	Content

IPSILATERAL ADRENALECTOMY FOR RENAL CELL CARCINOMA: MANDATORY STANDARD PROCEDURE OR OVERTREATMENT?

X. Giannakopoulos¹, K. Charalabopoulos^2,*, A. Charalabopoulos², N. Sofikitis¹

¹Department of Urology,
²Department of Physiology, Clinical Unit, Medical Faculty, University of Ioannina, Ioannina, Greece

Abstract. Standard radical nephrectomy entails en block removal of the kidney together with Gerota’s fascia and the ipsilateral adrenal. According to the refinement of imaging techniques (ultrasound, C/T scan and MRI), smaller tumors are being diagnosed. In addition, direct extension to the adrenal gland or adrenal metastasis can be detected in most cases. This is why several authors reserve adrenalectomy for large and/or upper pole tumors or abnormal appearing glands on preoperative C/T scan. However, preoperative diagnosis is not always accurate. Furthermore, micrometastatic adrenal invasion at the time of nephrectomy and late recurrences in the persistent adrenal have been documented, so that partisans of adrenalectomy only spare the adrenal in exceptional cases. The authors have reviewed several series in the literature and conclude that ipsilateral adrenalectomy can be omitted for small middle or lower pole tumors when the adrenal appears normal on the C/T scan and during the surgical intervention.

Key Words: renal cell carcinoma, radical nephrectomy, ipsilateral adrenalectomy, adrenal metastases, micrometastatic adrenal invasion

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