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Minerva Urologica e Nefrologica 2019 Jun 04

DOI: 10.23736/S0393-2249.19.03440-4


lingua: Inglese

Identifying tumor-related risk factors for simultaneous adrenalectomy in patients with cT1 - cT2 kidney cancer during robotic assisted laparoscopic radical nephrectomy

Jorge DAZA 1 , Alp T. BEKSAC 1, Muthumeena KANNAPPAN 1, Julio CHONG 1, Ronney ABAZA 2, Ashok HEMAL 3, John P. SFAKIANOS 1, Ketan K. BADANI 1

1 Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 2 Robotic Urologic Surgery, Ohio Health Dublin Methodist Hospital, Columbus, OH, USA; 3 Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA


BACKGROUND: In some cases, preservation of adrenal gland could be at risk in patients with cT1 and cT2 RCC. The aim of this study is to evaluate tumor-related factors that can potentially increase the risk of simultaneous adrenalectomy during robotic-assisted laparoscopic radical nephrectomy (RALRN) in patients with cT1 - cT2 disease and the impact of performing such procedure on recurrence-free survival (RFS) and complication rates.
METHODS: We used a multi-institutional kidney cancer database where we identified patients who underwent RALRN with or without adrenalectomy. We evaluated the tumor-related characteristics that could potentially increase the risk of adrenal gland resection of these patients. We also reported RFS at 12 - 24 months of follow-up, which was compared with an inverse probability of treatment weighted (IPTW) multivariable cox proportional hazards regression model and post-operative complications, which was compared with an IPTW multivariable logistic regression model.
RESULTS: Tumor size, cT stage, pT stage, histologic subtype, sarcomatoid differentiation, BMI, lymph node involvement, metastatic disease, Fuhrman grade do not increase the risk of simultaneous adrenalectomy during RALRN. Moreover, RALRN with adrenalectomy had no significant benefit in RFS. No differences in post-operative complications were noted.
CONCLUSIONS: Our evaluated tumor-related characteristics did not show to impact the incidence of simultaneous adrenalectomy. Adrenal gland resection T does not provide significant benefit in recurrence-free survival. We consider that RALRN with adrenalectomy should be reserved only for patients with adrenal compromise as stated previously regardless that it has shown to be a safe procedure.

KEY WORDS: Adrenalectomy - Renal cell carcinoma - Robotic assisted radical nephrectomy - Complications - Outcomes

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