Posted by CLDing on February 14, 1998 at 20:05:21:
In Reply to: Re: Renal & adrenal mass posted by hinwai on February 14, 1998 at 07:01:40:
Thanks Hin Wai for the summary of Belldegrun's paper (he was chief resident at the
Brighams when Gittes was Professor and Chief, when I visited for a month in 1984). The
literature on incidentaloma is a bit controversial. Size is useful as a guideline
certainly. Bell's criteria for renal adenoma is also debated. The guideline laid out is
certainly useful. Is the MRI finding backed up by any other workers? Sounds interesting
but is it like USS prostate and CaP or not - i.e. dependent on whose opinion it is.
Regarding leaving the adrenal behind, it certainly would be foolish to do so if it is
obviously infiltrated i.e. there is no plane of dissection between the upper pole of the
kidney and the adrenal. To stimulate further discussion on this matter, let me pose this
question. If you have bilateral renal tumour, would you opt for bilateral nephrectomy and
go on dialysis k.i.v. transplant, OR would you opt for parenchymal sparing surgery on both
sides.
Technically, parenchymal sparing surgery is possible most of the time (must show you some
X-rays when and if you do come to Ipoh). Necessity becomes the mother of industry (I mean
effort).
There is certainly no harm removing both adrenals (used to do it for Cushings) and put the
patient on replacement steroids (watch out though, cortisone acetate is difficult to come
by in this country now!!). Is there any literature that leaving the adrenal behind makes
any difference to the prognosis? Has anyone of us had any local recurrence without the
primary disease having breached the capsule or more commonly(in my experience) infiltrated
the peritoneum. I am not proposing routine leave behind for unilateral disease though!
I am doing a patient tomorrow - wish she had gone to someone else though! Will post her
problem another time.