Reconsidering the necessity of ipsilateral adrenalectomy during radical nephrectomy for renal cell carcinoma

Leibovitch, Ilan; Raviv, Gil; Mor, Yoram; Nativ, Ofer; Goldwasser, Benad

doi:10.1016/s0090-4295(99)80213-1

Cited by 55 publications

(41 citation statements)

References 42 publications

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“…21 In appropriately selected patients, 10-year cancer-specific survival is equivalent whether or not the adrenal gland is removed. 5 Furthermore, unnecessary removal of the adrenal gland may be associated with significant morbidity related to adrenal insufficiency. 14 Rates of adrenal removal have decreased only slightly between 1995 (40%) and 2004 (35%), 22 perhaps related to a lack of appreciation of the possible long-term consequences related to adrenal insufficiency.…”

Section: Discussionmentioning

confidence: 99%

“…In appropriately selected patients, adrenalectomy does not provide additional oncologic advantage, yet preservation of the adrenal gland may prevent unnecessary morbidity and reduce the risks of adrenal insufficiency. 5 Implementation of practice-changing evidence in surgery can be delayed. With regards to the aforementioned evidence in kidney cancer surgery, we have witnessed a slow uptake of these contemporary techniques.…”

Section: Introductionmentioning

confidence: 99%

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A population based study of surgeon characteristics associated with the uptake of contemporary techniques in renal surgery

Yap

Alibhai

Margel

et al. 2013

CUAJ

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Introduction: We have witnessed the slow uptake of many contemporary techniques in the surgical management of renal tumours. We sought to evaluate surgeon-level characteristics associated with the uptake of laparoscopy, partial nephrectomy (PN) and adrenalsparing approaches in surgically managing these tumours. Methods: Using the Ontario Cancer Registry, we identified surgeons treating renal cell carcinoma (RCC) in the province of Ontario, Canada between 2002 and 2004. We then classified individuals within this cohort as either high or low utilizers of laparoscopy, PN or adrenal-sparing approaches. Further variables analyzed included academic status, surgeon graduation year and surgical volume status. We then used univariable and multivariable logistic regression models to assess predictors of uptake. Results: We evaluated a total of 108 surgeons for their uptake of both laparoscopy and adrenal-sparing approaches and 94 surgeons for their uptake of PN. We identified 32 surgeons (30%) as high users of laparoscopy. Predictors of uptake of laparoscopy included graduation year after 1990 (odds ratio [OR] 4.81, confidence interval [CI] 1.57-14.8) and high-surgeon volume (OR 4.33, CI 1.60-10.4). We identified 41 surgeons (44%) as high users of PN. The only predictor of uptake of PN was academic status (OR 5.83,. We identified 69 surgeons (65%) as high users of adrenal-sparing approaches, but did not identify any significant predictors for uptake in this group. Discussion: We identify unique factors contributing to the uptake of distinct surgical techniques in the management of RCC. This information sheds lights on the underlying mechanisms and helps us understand how to further encourage the dissemination of these practices.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A population based study of surgeon characteristics associated with the uptake of contemporary techniques in renal surgery

Yap

Alibhai

Margel

et al. 2013

CUAJ

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“…Open radical nephrectomy was the standard curative intervention for localised RCC for the past five decades [2]. Furthermore, there were controversies over whether radical nephrectomy should be performed in conjunction with ipsilateral adrenalectomy as originally described by Robson, or if the adrenal should be preserved [3][4][5][6] and whether ipsilateral extended retroperitoneal lymphadenectomy or limited hilar lymphadenectomy should be performed [7,8].…”

Section: Introductionmentioning

confidence: 99%

Systematic Review of Oncological Outcomes Following Surgical Management of Localised Renal Cancer

MacLennan

Imamura

Lapitan³

et al. 2012

European Urology

304

174

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Context: Renal cell carcinoma (RCC) accounts for 2-3% of adult malignancies. There remain uncertainties over the oncological outcomes for the surgical management of localised RCC. Objective: To systematically review relevant literature comparing oncological outcomes of surgical management of localised RCC (T1-2N0M0). Evidence Acquisition: Relevant databases including MEDLINE, Embase and the Cochrane Library were searched up to October 2010, and an updated scoping search was performed up to January 2012. Randomised or quasi-randomised controlled trials (RCTs), prospective observational studies with controls, retrospective matched-pair studies, and comparative studies from well defined registries/databases were included. The main outcomes were overall survival, cancer-specific survival, recurrence and metastases. The Cochrane risk of bias (RoB) tool was used to assess RCTs and an extended version was used to assess Non Randomised Studies (NRS). The quality of evidence was assessed using GRADE. Evidence Synthesis: 4580 abstracts and 389 full text articles were assessed. 34 studies met the inclusion criteria (6 RCTs and 28 NRSs). Meta-analyses were planned but were deemed inappropriate due to data heterogeneity. There were high risks of bias and low quality evidence across the evidence base. Open radical nephrectomy and open partial nephrectomy showed similar cancer-specific and overall survival, but when both open and laparoscopic approaches are considered together the evidence showed improved survival for partial nephrectomy for tumours ≤4cm.Overall, the evidence suggests either equivalent or better survival with partial nephrectomy. Laparoscopic radical nephrectomy offered equivalent survival to open radical nephrectomy, and all laparoscopic approaches achieved equivalent survival. Open and laparoscopic partial nephrectomy achieved equivalent survival. The issue of ipsilateral adrenalectomy or complete lymph node dissection with radical nephrectomy or partial nephrectomy remains unresolved. Conclusions: The evidence base suggests localised RCC are best managed by nephron sparing surgery where technically feasible. However, the current evidence base has significant limitations due to studies of low methodological quality marked by high risks of bias.

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“…Therefore, the detection of RCC before symptoms enables treatment of less harming tumors and provides a better prognosis for the patient. (9,10) Majority of patients had T2 stage disease and 3 patients had inferior venacaval thrombus below diaphragm with no vein wall invasion (Table 2). 66% T3b patients had no disease free survival at one year.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Observational Study on Effectiveness of Prognostic Factors Influencing Disease Free Survival in Renal Cell Carcinoma

Akaasapu¹,

Ravichandar²,

T³

et al. 2015

jemds

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AIMS AND OBJECTIVES:To study the effectiveness of prognostic factors influencing the disease free survival in non-metastatic renal cell carcinoma. To access how well the available study designs such as UNIVERSITY OF CALIFORNIA AND LOS ANGELS and SSIGN could be used to access the prognosis of renal carcinoma on hand. INCLUSION CRITERIA: All the patients undergoing radical nephrectomy for renal cell carcinoma above 18 years of age are included in the study. EXCLUSION CRITERIA: All the patients with renal cell carcinoma under the age of 18 are excluded. All the metastatic renal cell carcinoma patients were excluded. All the patients with bilateral renal cell carcinoma are excluded. MATERIALS AND METHODS: A prospective case series study was conducted after getting approval from thesis committee in the Department of Urology, and followed up in the Department of Urology; Gandhi medical College, Secundrabad, for a period of 12 months from June 2012 to May 2013. RESULTS: A total of 30 patients with non-metastatic renal cell carcinoma who underwent radical nephrectomy were followed up for one year. At the end of one year follow up 24 patients (80%) had one year disease free survival. Previous studies to compare prognostic factors of renal cell carcinoma for disease free survival at 1 year are limited and hence the results are compared to studies of five years of follow up. CONCLUSION: Our follow-up guidelines after nephrectomy for non-metastatic RCC, based on an integrated stage-specific, and tumor size protocol, stratifying patients in to risk groups showed to be useful to predict recurrence and survival in patients with non-metastatic RCC. Among the clinical related prognostic factors age, mode of presentation had no independent prognostic information at one year of follow up but performance status proved to be a significant prognostic factor. Among tumor related prognostic factors, RCC subtypes and nuclear grade had no independent prognostic value but tumor size, nodal positivity, presence of necrosis and staging had independent prognostic value. Among serum markers, ESR has no prognostic value. The available prognostic models like UCLA and SSIGN designs proved to be useful models for accessing prognosis of non-metastatic renal cell carcinoma at one year of follow up.

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Reconsidering the necessity of ipsilateral adrenalectomy during radical nephrectomy for renal cell carcinoma

Cited by 55 publications

References 42 publications

A population based study of surgeon characteristics associated with the uptake of contemporary techniques in renal surgery

A population based study of surgeon characteristics associated with the uptake of contemporary techniques in renal surgery

Systematic Review of Oncological Outcomes Following Surgical Management of Localised Renal Cancer

A Prospective Observational Study on Effectiveness of Prognostic Factors Influencing Disease Free Survival in Renal Cell Carcinoma

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