Document Detail

Ipsilateral adrenalectomy at the time of radical nephrectomy impacts overall survival.
MedLine Citation:
PMID:  23039377     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To assess the impact of ipsilateral adrenalectomy on overall survival, we performed a population-level analysis. Ipsilateral adrenal-gland-sparing approaches during radical nephrectomy (RN) remain under-utilized and the long-term consequences of an iatrogenic solitary adrenal gland are poorly understood.
PATIENTS AND METHODS: Using the Ontario Cancer Registry we identified 1651 patients in the province of Ontario, Canada, with pT1a renal cell carcinoma who underwent RN between 1995 and 2004. We linked individual patient information with pathological data from abstracted pathology reports and determined whether the ipsilateral adrenal gland was removed at the time of RN. We utilized univariable and multivariable (adjusting for age, gender, tumour size and tumour grade) Cox proportional hazard models and Kaplan-Meier curves to assess predictors of overall and cancer-specific survival.
RESULTS: The overall rate of ipsilateral adrenalectomy at the time of RN was 30%. Median follow-up for the cohort was 109 months. Adrenal removal was associated with worse overall survival: 10-year mortality 26% compared with 20% for those in whom the adrenal gland was left in situ. Factors predictive of worse overall survival on multivariable analysis were increasing age (hazard ratio [HR] 1.07 per year, CI 1.06-1.08), high grade tumours (HR 1.38, 1.00-1.90) and having undergone ipsilateral adrenalectomy (HR 1.23, 1.00-1.50). Ipsilateral adrenalectomy was not predictive of cancer-specific survival (HR 1.18, 0.78-1.79).
CONCLUSIONS: We demonstrated a significant association between ipsilateral adrenalectomy and overall survival. Our findings further support the importance of adrenal-sparing approaches at the time of RN.
Stanley A Yap; Shabbir M H Alibhai; Robert Abouassaly; Narhari Timilshina; David Margel; Antonio Finelli
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Publication Detail:
Type:  Journal Article     Date:  2012-10-08
Journal Detail:
Title:  BJU international     Volume:  111     ISSN:  1464-410X     ISO Abbreviation:  BJU Int.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-03-04     Completed Date:  2013-04-22     Revised Date:  2013-10-24    
Medline Journal Info:
Nlm Unique ID:  100886721     Medline TA:  BJU Int     Country:  England    
Other Details:
Languages:  eng     Pagination:  E54-8     Citation Subset:  IM    
Copyright Information:
Division of Urologic Oncology, Princess Margaret Hospital, University of Toronto, Canada.
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MeSH Terms
Adrenalectomy* / methods
Aged, 80 and over
Carcinoma, Renal Cell / mortality*,  surgery*
Kidney Neoplasms / mortality*,  surgery*
Middle Aged
Nephrectomy* / methods
Retrospective Studies
Survival Rate
Young Adult
Comment In:
J Urol. 2013 Oct;190(4):1205   [PMID:  24029305 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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