Posted by C S Loh on February 15, 1998 at 09:52:19:
In Reply to: Re: Renal & adrenal mass posted by hinwai on February 15, 1998 at 01:29:56:
Ipsilateral adrenal involvement is encountered in some 4% of radical nephrectomy series. It is important to separate those due to direct invasion from those due to metastasis (prognosis is the same, whether ipsi or contralateral). Thus, if the adrenal had been directly invaded (usu. obvious pre-op on CT) adrenal extirpation should be done to improve local control. In series in which adrenal involvement was due to metastatic deposits, adrenal extirpation does not appear ro add significantly to survival. Indeed, it had been suggested that direct invasion should be staged pT3d while adrenal met M1. Having said that, in unilateral tumour, adrenalectomy does not add to morbidity and even if it does not improve outcome significantly, it aids in the staging of the tumour and therefore should be carried out. I this case, I actually opted for adrenal preservation as ipsilateral adrenal appear normal on CT.
I share Hin Wai's approach with bilateral tumours, i.e., deal with the smaller one first. If tumour completely extirpated with sufficient nephron preservation, proceed to total nephrectomy of the larger tumour.
In this patient, a radical nephrectomy was carried out through the loin approach. Nodes
were negative but perinephric fat involved. Adrenal was preserved and I planned to re-CT
her left adrenal in 3 month (which is about now!) I will keep all posted.