Adrenalectomy Rates Remain High in Radical Nephrectomy

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During a recent 10-year period, the rate of ipsilateral adrenalectomy at the time of radical nephrectomy decreased slightly, a study found.

Stanley A. Yap, MD, of the University of Toronto, and colleagues identified 5,135 patients who underwent radical nephrectomy between 1995 and 2004, and used pathology reports to assess ipsilateral adrenalectomy and tumor involvement of the adrenal gland.

The researchers found a 1.4% overall rate of adrenal gland involvement with cancer (74 cases). In tumors larger than 7 cm, the adrenal gland was involved in 3.2% of tumors, compared with 0.89% and 0.63% of tumors 4 to 7 cm or smaller than 4 cm, respectively, according to a report in The Journal of Urology (2012;187:398-404).

The overall adrenalectomy rate was 40.1%, and decreased from 40.6% in 1995 to 34.8% in 2004. On multivariable analysis, factors associated with adrenal removal included tumors larger than 7 cm, presence of venous thrombus, upper pole location, higher hospital volume, and academic status of the surgeon or hospital.

"Despite evidence to support preservation of the ipsilateral adrenal gland during radical nephrectomy, the rate of adrenalectomy decreased only slightly in 10 years. Adrenalectomy remains overused in populations that are unlikely to benefit from the procedure," the authors concluded.

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