Radikal nefrektomi öncesi radyolojik ve peroperatif bulgular aynı taraflı adrenalektomi yapmak için bize ne kadar yol göstericidir?

Abstract

Amaç: Adrenal bez tutulumunu öngörebilmek için preoperatif radyolojik görüntüleme bulguları, peroperatif muayene bulguları ile postoperatif patolojik bulguları değerlendirmeyi amaçladık.Gereç ve Yöntemler: 2005-2012 yılları arasında, üç farklı merkezde, böbrek hücreli kanser tanısı almış ve radikal nefrektomi ile birlikte aynı taraflı adrenalektomi yapılan 69 hasta değerlendirildi. Tüm hastaların demografik bulguları ve preoperatif tüm abdomen bilgisayarlı tomografi BT görüntülerindeki tümör boyutu, tarafı, yerleşimi kayıt edildi. Hastalar; operasyon öncesi BT’deki adrenal bezin durumu, peroperatif palpasyon bulguları ve operasyon sonrası histopatolojik incelemedeki adrenal bez tutulumu açısından değerlendirildi.Bulgular: Olguların 25’i %36,2 kadın ve 44’ü %63,8 erkek olup ortalama yaşları sırasıyla 59.7±12.4 ve 58.2±11.9 yıl idi. Ortalama tümör boyutu 7.9±3 cm 2.4-16 cm idi. Preoperatif BT raporlarında 6 olguda %8,6 adrenal bez tutulumunu düşündürecek bulgular mevcuttu. Bu 6 hastada BT görüntülemesinde adrenal bezde yüzey düzensizliği ve nodüler formasyonu olarak tarif edilen olası tutulum bulguları mevcuttu. Altı hastanın 3’ünde peroperatif palpasyon ile yapılan muayenede adrenal tutulum bulguları mevcuttu. Bu hastaların histopatolojik incelemelerinde de adrenal bezde patolojik olarak tümör tespit edildi. Bir hastada Conclusion: Consistent with the recent literature, we found that routine adrenalectomy in addition to the radical nephrectomy is unnecessary, particularly when pre-operative CT and peroperative findings are negative. In addition, we think that peri-operative palpation findings are as valuable as pre-operative radiological findings in the prediction of adrenal gland involvement

Keywords

• Adrenal bez,renal tümör,radikal nefrektomi

How radiologic and per-operative findings before radical nephrectomy would guide us for performing ipsilateral adrenalectomy?

Abstract

Objective: The aim of this study is to evaluate the role of pre-operative radiologic imaging findings, per-operative findings, and post-operative pathological examination in the prediction of adrenal gland involvement.Material and Methods: Between 2005 and 2012, from 3 different hospitals, medical records of 69 patients who had radical nephrectomy with ipsilateral adrenalectomy for renal cell carcinoma were reviewed. Demographic data and preoperative abdominal computerized tomography CT findings including size, side and localization of the tumor were recorded. Pre-operative condition of the adrenal gland in CT, per-operative palpation findings, and post-operative histopathological examination were evaluated.Results: 25 patients 36.2% were female and 44 63.8% were male with a mean age of 59.7 ± 12.4 and 58.2 ± 11.9 years, respectively. Mean tumor size was 7.9 ± 3 cm . In 6 cases 8.6% , we have found an evidence suggesting adrenal gland involvement in pre-operative CT. These six patients had possible signs of adrenal involvement in CT, described as irregular surface and nodule formation. The three of six patients had signs of adrenal involvement on per-operative palpation. In histopathological examination of these patients, tumor involvement was detected in adrenal gland. In one patient tumor involvement in adrenal gland was detected without preoperative CT findings.Conclusion: Consistent with the recent literature, we found that routine adrenalectomy in addition to the radical nephrectomy is unnecessary, particularly when pre-operative CT and peroperative findings are negative. In addition, we think that peri-operative palpation findings are as valuable as pre-operative radiological findings in the prediction of adrenal gland involvement

Keywords

• Adrenal gland,kidney tumor,radical nephrectomy

References

1. Siegel R, Naishadham D, Samuels A. Cancer statistics, 2012. CA Cancer J Clin 2012;62:10-29.
2. Robson CJ, Churchill BM, Anderson W. The results of ra- dical nephrectomy for renal cell carcinoma. J Urol 1969 ;101:297-301.
3. Willis, R.: Secondary tumors of the adrenals. In: The Spread of Tumours in the Human Body, 2nd ed. London: Butter- worths and Co; 1952.p. 199.
4. Hellsten S, Berge T, Linell F. Clinically unrecognised renal carcinoma: aspects of tumor morphology, lymphatic and hematogenous metastatic spread. Br J Urol 1983;55:166-70.
5. Shorr AB, Conroy JD, Garofano CD et al. 20% incidence of adrenocortical insufficiency in metastatic hypernephroma. Clin Res 1986; 34: 200A
6. Van Laar JA, Grool N, Feelders RA. Adrenal insufficiency occurring seven years after nephrectomy for renal cell can- cer. Acta Oncol 2007;46:121-2.
7. Yap SA, Alibhai SM, Abouassaly R, Timilshina N, Finelli A. Do we continue to unnecessarily perform ipsilateral adre- nalectomy at the time of radical nephrectomy? A populati- on based study. J Urol 2012;187:398-404.
8. Lane BR, Tiong HY, Campbell SC et al. Management of the adrenal gland during partial nephrectomy. J Urol 2009;181:2430-7.

9. Yap SA, Alibhai SM, Abouassaly R et al. Ipsilateral adrena- lectomy at the time of radical nephrectomy impacts overall survival. BJU Int 2013;111:54-8.
10. Tsui KH, Shvarts O, Barbaric Z, Figlin R, de Kernion JB, Belldegrun A. Is adrenalectomy a necessary component of radical nephrectomy? UCLA experience with 511 radical nephrectomies. J Urol 2000;163:437-41.
11. Paul R, Mordhorst J, Busch R, Leyh H, Hartung R. Adre- nal sparing surgery during radical nephrectomy in patients with renal cell cancer: a new algorithm. J Urol 2001;166:59- 62.
12. Kutikov A, Piotrowski ZJ, Canter DJ et al. Routine adre- nalectomy is unnecessary during surgery for large and/or upper pole renal tumors when the adrenal gland is radiog- raphically normal. J Urol 2011;185:1198-203.
13. Weight CJ, Kim SP, Lohse CM et al. Routine adrenalectomy in patients with locally advanced renal cell cancer does not offer oncologic benefit and places a significant portion of patients at risk for an asynchronous metastasis in a solitary adrenal gland. Eur Urol 2011;60:458-64.
14. O’Malley RL, Godoy G, Kanofsky JA, Taneja SS. The neces- sity of adrenalectomy at the time of radical nephrectomy: a systematic review. J Urol 2009;181:2009-17.
15. Gill IS, McClennan BL, Kerbl K, Carbone JM, Wick M, Clayman RV. Adrenal involvement from renal cell carcino- ma: predictive value of computerized tomography. J Urol 1994;152:1082-5.
16. Autorino R, Di Lorenzo G, Damiano R et al. Adrenal spa- ring surgery in the treatment of renal cell carcinoma: when is it possible? World J Urol 2003;21:153-8.
17. Atan A, Tuncel A, Aslan Y et al. Is computerized tomog- raphy reliable for detecting tumor number and adrenal gland involvement in patients with renal cell cancer? a mul- ticenter study. Türk Üroloji Dergisi 2005:31:329-334.