Introduction

During the past decade, the role and indications of adrenalectomy as part of radical nephrectomy for renal cell carcinoma have been clearly defined. In contrast, the impact of synchronous adrenalectomy during radical nephroureterectomy for upper tract urothelial carcinoma (UTUC) has never been evaluated. The aim of this study was to assess the impact of adrenal resection during radicla nephroureterectomy for UTUC.

Methods

_x000D_ The charts of all patients who underwent nephroureterectomy for upper tract urothelial carcinoma in a single-center between 1994 and 2014 were retrospectively reviewed. Patients were divided into two groups: synchronous ipsilateral adrenalectomy (A) and no synchronous ipsilateral adrenalectomy (NA). Perioperative outcomes (operative time, complications, positive margins, ...) were compared between the 2 groups using ?2 and Mann-Whitney tests. Survival outcomes were estimated using the Kaplan-Meier method. The impact of synchronous adrenalectomy on cancer-specific-survival (CSS) and recurrence-free survival (RFS) was evaluated using the log-rank test._x000D_

Results

_x000D_ One hundred and forty five patients were included in the study. Among them 21 had synchronous ispilateral adrenalectomy but only one adrenal specimen was invaded by the UTUC on final pathology (4.8%) and this invasion was diagnosed on preoperative imaging. Synchronous adrenalectomy had no impact in terms of operative time (265 vs. 241 min; p = 0.22), transfusion rate (20% vs. 18.4%; p = 0.87), complication rate (38.1% vs. 39.8%; p = 0.89) or positive margins (9.6% vs. 13.2%; p = 0.64). CSS (79.6% vs. 62.8%; p = 0.18) and RFS (70% vs. 56.6%; p =0.33) at 5 years were comparable between both groups_x000D_

Conclusions

_x000D_ In this single-center series, adrenal resection during nephroureterectomy for UTUC did not increase perioperative morbidity but did not provide oncologic benefit. Adrenal invasion by UTUC was rare (4.8%) and diagnosable on preoperative imaging. Hence, routine ipsilateral adrenalectomy during radical nephroureterectomy may not be indicated._x000D_

Funding

none