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Contralateral adrenal metastasis of renal cell carcinoma: treatment, outcome and a review
Author(s) -
Lau W.K.,
Zincke H.,
Lohse C.M.,
Cheville J.C.,
Weaver A.L.,
Blute M.L.
Publication year - 2003
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1046/j.1464-410x.2003.04237.x
Subject(s) - medicine , renal cell carcinoma , nephrectomy , adrenalectomy , metastasis , perioperative , adrenal gland , pathological , surgery , carcinoma , metastatic carcinoma , autopsy , medical record , kidney , cancer
The group from the Mayo Clinic review their experience with contralateral adrenal metastasis in 11 patients, two with synchronous and nine with metachronous metastases, all being treated by adrenalectomy. Although nine of the 11 patients had died from RCC by the time of review, the authors felt that removal of contralateral adrenal metastasis had a beneficial effect; this sustains the belief that surgical removal of solitary metastases is advisable.Urologists from London address the concept of surgical variables as being of major importance. We will be hearing more about ‘under performing surgeons’, and I felt that an editorial comment from two European urologists would help to put the article in place for the reader. I can guarantee that further views are on their way about this important topic.Screening for prostate cancer has occupied many column inches in most urological Journals, and readers are of course aware of the randomized studies being conducted in North America, Europe and elsewhere. Authors from South Africa describe some of the problems associated with developing a screening programme in a less developed part of the world. They show that it can be extremely difficult to induce patients screened for the PSA to attend for their prostate biopsy.OBJECTIVE To report the surgical treatment of patients with renal cell carcinoma (RCC) metastatic to the contralateral adrenal gland and compare our experience with previous reports, as such metastases are found in 2.5% of patients with metastatic RCC at autopsy, and the role of resecting metastatic RCC at this site is not well defined. PATIENTS AND METHODS We retrospectively identified 11 patients who had surgery for metastatic RCC to the contralateral adrenal gland between October 1978 and April 2001. The patients’ medical records were reviewed for clinical, surgical and pathological features, and the patients’ outcome. RESULTS The mean (median, range) age of the patients at primary nephrectomy was 60.9 (64, 43–79) years; all had clear cell (conventional) RCC. Synchronous contralateral adrenal metastasis occurred in two patients. The mean (median, range) time to contralateral adrenal metastasis after primary nephrectomy for the remaining nine patients was 5.2 (6.1, 0.8–9.2) years. All patients were treated with adrenalectomy; there were no perioperative complications or mortality. Seven patients died from RCC at a mean (median, range) of 3.9 (3.7, 0.2–10) years after adrenalectomy for contralateral adrenal metastasis; one died from other causes at 3.4 years, one from an unknown cause at 1.7 years and two were still alive at the last follow‐up. CONCLUSIONS The surgical resection of contralateral adrenal metastasis from RCC is safe; although most patients died from RCC, survival may be prolonged in individual patients. Hence, in the era of cytoreductive surgery, the removal of solitary contralateral adrenal metastasis seems to be indicated.