Search

To analyse the necessity of obligatory ipsilateral adrenalectomy (IA) for renal cell carcinoma (RCC), we made a study of 329 RCC patients operated from 2002 to 2007. Nephrectomy was conducted in 208 (63.2%) patients, renal resection--in 121 (36.8%), adrenalectomy--in 19 (5.8%) patients. High-contrast multislice computed tomography (HCMCT) was performed in all the patients. Preoperative HCMCT detected adrenal lesions in 62 (18.84%) patients. Adrenal adenoma was suspected in 39 (11.8%) patients: ipsilateral in 19 (48.77%), contralateral in 11 (28.23%), bilateral in 9 (23%) patients. Adrenal hyperplasy was diagnosed in 11 (3.34%) patients. It was ipsilateral in 5 (45.4%), contralateral in 4 (36.4%), bilateral in 2 (18.2%) patients. The tumor invaded the ipsilateral adrenal in 4 (1.2%) patients. A RCC metastasis into the adrenal was suspected in 8 (2.4%) patients. A synchroneous affection was seen in 5 (1.5%) patients: ipsilateral in 4 (80%) and bilateral in 1 (20%) patients. RCC invaded the ipsilateral adrenal in 1.2% patients with RCC, its adrenal metastasis was detected in 1.5% RCC patients. In preservation of the adrenal in adenoma or hyperplasy 5-year follow-up registered no changes. Neither pathological processes were diagnosed for 5 years in preservation of unaffected adrenal. Thus, adrenalectomy is not obligatory in radical nephrectomy.

The aim of the study was assessment of diagnosis and surgical treatment of adrenal metastases (AM) of renal carcinoma (RC). 10 cases of RC AM have been analysed. Bilateral metastases were diagnosed in 2 patients, ipsilateral in 5 patients, contralateral in 3. Three patients had synchronous metastases, seven had metachronous ones. AM were detected 8 months to 14 years after after operation on the kidney. Non-invasive dynamic control over the retroperitoneal space after nephrectomy for RC using advanced visual methods (ultrasonography, x-ray and resonance magnetic CT) not only detects AM but also determines metastatic genesis of the tumor. Thus, significant verification of RC AM, especially of metachronous origin, requires the study of the findings obtained at clinical, laboratory, ultrasonic, radiation examinations as well as comparison of histological structure of the removed kidney tumor and the adrenal. Early diagnosis and removal of a solitary adrenal metastasis of RC provides prolongation of the patient's life and survival of patients with RC late stages.

Despite significant advances in surgical oncourology, local recurrence of renal cell carcinoma (RCC) remains a serious problem both for the doctor and the patient. Our study of treatment outcomes in local recurrent RCC consisted in a retrospective analysis of 13 patients with a local RCC recurrence in the renal fossa treated with surgical resection alone between 1991 and 2003. Twelve patients demonstrated no evidence of distant metastases at the time of the recurrence. One patient had a synchronous metastasis to the contralateral adrenal gland. A mean recurrence-free interval was 14.6 months (range 2-96 months) after nephrectomy. 46% patients demonstrated symptoms of weight loss, fatigue and lumbar pains. The source of local recurrence in 2 patients was metachronous metastases to the ipsylateral adrenal gland, in 1 patients--a tumor thrombus in the remnant of the left renal vein, in 3--soft tissues of the renal fossa and in 7--metastases to the regional lymph nodes. 13 resections were performed with one intraoperative death and one immediate postoperative death. Splenectomy was made in 2 patients, resection of the stomach in 1, distal pancreatectomy in 1, resection of the inferior vena cava in 3, aorta in 1. The average blood loss was 800 ml (300-4500 ml). Up to now 6 patients survived. Of 5 decreased patients 4 died of progressive disease in 1, 4, 10 and 16 months. 1 patient died of cause unrelated to cancer recurrence in 14 months. Out of 6 alive patients 4 have no signs of the disease for, on the average, 31.6 months (range 4-78 months) and 2 patients have obvious progression of the disease (1--repeated local recurrence, 1--distant metastases) 9 and 15 months after the operation. We believe that an aggressive surgical approach to a local RCC recurrence can produce an increase in disease-free survival and significantly improve quality of life for such patients.

We analysed case records of 2507 patients with renal cell carcinoma treated in the department of onco-urology of Cancer Research Center (Moscow). 1939 of them underwent nephrectomy between 1971 and 1999. The overall incidence of adrenal metastases according to CT and histological findings was 4.7%. Synchronous metastases occurred in 90 and metachronous ones in 30 patients. Radical nephrectomy with adrenalectomy was performed in 18 out of 90 patients with synchronous metastases, palliative nephrectomy in 20 and 52 patients were not considered for surgery. Among 18 patients who underwent complete surgical resection, 12(66%) had either lymph node involvement or distant metastases. A microscopic metastasis was found on histological examination only in 1 patient with normal CT scan and macroscopically intact adrenal on intraoperative assessment. Mean survival after radical nephrectomy with adrenalectomy in 6 patients with solitary lesions was 57 months compared to the longest survival of 31 months in patients with widespread disease. Solitary metachronous ipsilateral and contralateral adrenal involvement was present in 7 patients. The average interval between nephrectomy and appearance of adrenal metastasis in this group was 73 months. One patient was lost for follow-up and one died of adrenal deficiency 4.3 months after adrenalectomy. One patient underwent a consecutive removal of brain and lung metastases 33 and 38 months following adrenalectomy while the remaining 4 were alive in 15, 16, 26 and 34 months with no evidence of the disease. Thus, ipsilateral adrenalectomy is obligatory only in patients with severe disease as shown by CT scan or at nephrectomy. About one-third of the patients will benefit from the surgery. Adrenalectomy should be performed in case of obvious adrenal involvement. The aggressive surgical approach is justified in solitary metachronous adrenal involvement because of long-term survival expected in some of such patients.

To clarify the frequency of involvement of the collateral adrenal in patients with renal cell carcinoma (RCC) and to formulate indications to adrenalectomy in performing radical nephrectomy, the author assessed treatment results in 130 RCC patients (73 males and 57 females, mean age 52.6 +/- 0.3 years). 36 subjects had T2N0M0, 48--T3N0M0, 46--T4N0M0. Preoperatively, all the patients were divided into prognostic groups. Irrespective of the prognosis, 102 patients underwent radical nephrectomy. 18 patients with uncertain prognosis and 10 patients with good prognosis were subjected to nephrectomy without adrenalectomy. Metastases to the collateral adrenal were detected in 16.1%, 2.5% and 0% of patients with poor prognosis, uncertain and good prognosis, respectively. 5-year survival in groups with poor, uncertain and good prognosis was 28.6, 50 and 93.7%, respectively; in patients with uncertain prognosis after radical nephrectomy or nephrectomy without adrenalectomy it was 47.5 and 55.5%, respectively; with good prognosis--100 and 90%, respectively. In bad prognosis, the adrenal must be removed because of high metastatic risk. In RCC patients with uncertain or good prognosis in the absence of preoperative evidence on adrenal tumor adrenalectomy performed with nephrectomy does not improve 5-year treatment outcomes.

Effectivity of radiodiagnosis has been analyzed in 158 patients with adrenal disease, among them 112 and 117 hormone-active tumors, while 46 subjects had 54 hormone-inactive tumors. Computed tomography proved more sensitive in detection of hormone-active tumors and hyperplasia of the adrenals than ultrasonography (97% versus 62%). Radioimmunoassay of the blood outflowing from the adrenals adjuvant to their venography appeared informative in 18 out of 21 procedures. Computed tomography was also more effective in identification of adrenal hormone-inactive tumors (adenomas, metastases, cancer, etc.), its sensitivity being 100% against 44% for ultrasonography. In large-size tumors aortography only warrants determination of the tumor organic origin reliably. The diagnostic model is proposed for adrenal diseases. It uses stage-by-stage and purposeful application of radiologic investigations.

It is not always possible to verify with a sufficient degree of confidence malignant tumors of the abdominal cavity using computerized tomography (CT) and angiography. The paper is concerned with working out and specifying a method of CT angiotomography (CTA), based on ia administration (via the celiac trunk, the renal arteries) of a contrast medium to increase the informative value of CT imaging, followed by scanning. A conclusion has been made after 27 investigations that CTA is capable of providing more complete information on the nature of an abnormal process than CT (even with i.v. administrations) or angiography.

A new procedure for establishing the operability of lung cancer patients--direct suprarenoscopy--is discussed. The procedure was used in examining 6 patients with lung cancer. A detailed discription as well as indications and contraindications are given. A clinical case is reported. The method proved to be highly effective and promising.

Morphohistochemical and morphometric assays of the thymus from 40 persons, died as a result of cancer of various localizations, demonstrated a reliable diminishing in size of Hassell's corpuscles, the constant presence of blast thymocytes, an increased content of PAS-positive cells, reticuloepithelial dystrophy. Under lymphogenic metastasization and adrenal metastases the thymus may also increase its bulk. Some alternative changes in the thymus when involved by metastases are described.

A study of 115 lung cancer patients has shown that indications to the use of multi-modality gammascintigraphy or its separate variants are as follows: the presence of the clinical manifestations of distant metastases, data on a considerable local dissemination of a primary tumor to the lungs, poor differentiation by the histological structure.