radical nephrectomy

Spare the adrenal gland during radical nephrectomy

It has been standard of care to remove the adrenal gland aswell as kidney during radical nephrectomy for suspected renal cancer. However, Finelli et al show that survival is better if it is spared. In an article published in BJUI (2012) they report a study of 1,651 patients with a final pathological diagnosis of T1a RCC, including 490 patients (30%) who had concurrent ipsilateral adrenalectomy. By 10 years, the overall survival was 74.1% with adrenalectomy vs 79.8% when the adrenal was left behind (p<0.001), whilst cancer-specific survival did not differ. In a Cox proportional hazard model, ipsilateral adrenalectomy increased the risk of overall mortality by 23%, but it didn't affect cancer-specific survival.