Can We Spare Removing the Adrenal Gland at Radical Nephrectomy in Children With Wilms Tumor?
Summary of "Can We Spare Removing the Adrenal Gland at Radical Nephrectomy in Children With Wilms Tumor?"
PURPOSE:
In patients with Wilms tumor indications for adrenalectomy are not well-defined. Following the rationale for preserving the adrenal gland in cases of other renal malignancies we determined predictors of adrenal involvement and the impact of adrenalectomy on retroperitoneal recurrence. MATERIALS AND
METHODS:
We retrospectively reviewed the record of patients who underwent surgical resection as primary treatment for Wilms tumor between 1990 and 2008 at 2 Canadian pediatric centers. Patient and tumor characteristics were reviewed to determine potential links to adrenal involvement. Recurrence was evaluated as a time dependent variable based on followup duration.
RESULTS:
Of 180 patients diagnosed with Wilms tumor 95 underwent initial radical nephrectomy. Mean +/- SD age at diagnosis was 46 +/- 38 months and mean survival followup was 189 +/- 8.3 months. Disease was stage 1 to 4 in 28, 34, 23 and 4 patients, respectively. Adrenalectomy was done in 58 patients (61%). Only 1 adrenal gland was reportedly positive for tumor invasion while peri-adrenal fat involvement was noted in 3 patients. No studied patient or tumor characteristics predicted involvement. No statistically significant difference in retroperitoneal recurrence was found between the groups in which the adrenal gland was removed vs preserved.
CONCLUSIONS:
Adrenal involvement in patients with Wilms tumor is rare and difficult to predict. Preserving the adrenal gland was not associated with an increased risk of local recurrence. Thus, it seems prudent to avoid adrenalectomy at radical nephrectomy when technically feasible, instead attempting to otherwise remove all peri-adrenal fat with the specimen.
Affiliation
Divisions of Urology, Hospital for Sick Children, University of Toronto, Ontario and McMaster University, Hamilton, Ontario and Centre Hospitalier Universitaire de Québec, Université Laval, Québec, Canada.
Journal Details
This article was published in the following journal.
Name: The Journal of urology
ISSN: 1527-3792
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20728101
- DOI: http://dx.doi.org/10.1016/j.juro.2010.03.126
Medical and Biotech [MESH] Definitions
Waterhouse-friderichsen Syndrome
A condition caused by overwhelming BACTERIAL INFECTIONS or SEPTICEMIA, leading to HEMORRHAGE and NECROSIS of the ADRENAL GLAND. It is characterized by rapidly developing ADRENAL INSUFFICIENCY; HYPOTENSION; and widespread cutaneous PURPURA. This syndrome may occur at any age but is more common in children.
Adrenal Insufficiency
Conditions in which the production of adrenal CORTICOSTEROIDS falls below the requirement of the body. Adrenal insufficiency can be caused by defects in the ADRENAL GLANDS, the PITUITARY GLAND, or the HYPOTHALAMUS.
Adrenal Medulla
The inner portion of the adrenal gland. Derived from ECTODERM, adrenal medulla consists mainly of CHROMAFFIN CELLS that produces and stores a number of NEUROTRANSMITTERS, mainly adrenaline (EPINEPHRINE) and NOREPINEPHRINE. The activity of the adrenal medulla is regulated by the SYMPATHETIC NERVOUS SYSTEM.
Adrenal Glands
A pair of glands located at the cranial pole of each of the two KIDNEYS. Each adrenal gland is composed of two distinct endocrine tissues with separate embryonic origins, the ADRENAL CORTEX producing STEROIDS and the ADRENAL MEDULLA producing NEUROTRANSMITTERS.
Salt Gland
A compound tubular gland, located around the eyes and nasal passages in marine animals and birds, the physiology of which figures in water-electrolyte balance. The Pekin duck serves as a common research animal in salt gland studies. A rectal gland or rectal salt gland in the dogfish shark is attached at the junction of the intestine and cloaca and aids the kidneys in removing excess salts from the blood. (Storer, Usinger, Stebbins & Nybakken: General Zoology, 6th ed, p658)
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