Is adrenalectomy necessary during unilateral nephrectomy for Wilms Tumor? A report from the Children's Oncology Group

Kathleen Kieran*, James R. Anderson, Jeffrey S. Dome, Peter F. Ehrlich, Michael L. Ritchey, Robert C. Shamberger, Elizabeth J Perlman, Daniel M. Green, Andrew M. Davidoff

*Corresponding author for this work

Research output: Contribution to journalReview article

10 Citations (Scopus)

Abstract

Purpose To determine whether performing adrenalectomy at the time of nephrectomy for unilateral Wilms tumor impacts clinical outcome. Methods We reviewed information on all patients enrolled on National Wilms Tumor Study-4 and -5. Data were abstracted on patient demographics, tumor characteristics, surgical and pathologic status of the adrenal gland, and patient outcomes. The primary endpoints were intraoperative spill and five-year event-free survival (EFS) in patients who did or did not undergo adrenalectomy. Results Of 3825 patients with complete evaluable data, the adrenal was left in situ in 2264 (57.9%) patients, and was removed completely in 1367 patients (36.7%) or partially in 194 patients (5.2%). Of the adrenal glands removed, 68 (4.4%) contained tumor. Adrenal involvement was more common in patients with stage 3 (9.8%) than stage 2 disease (1.9%; p < 0.0001). After controlling for stage and histopathology, five-year EFS was similar whether or not the adrenal gland was removed (p = 0.48), or involved with tumor (p = 0.81); however, intraoperative spill rates were higher in patients undergoing adrenalectomy (26.1% vs 15.5%, p < 0.0001), likely due to larger tumor size or technical factors. No patient had clinical evidence of adrenal insufficiency or tumor recurrence in the adrenal gland during follow-up (median 9.9 years). Conclusions Sparing the adrenal gland during nephrectomy for unilateral Wilms tumor was not associated with a higher incidence of intraoperative spill and was associated with a similar oncologic outcome, on a per-stage basis, with cases where the adrenal was removed. Thus, adrenalectomy should not be considered mandatory during radical nephrectomy for Wilms tumor.

Original languageEnglish (US)
Pages (from-to)1598-1603
Number of pages6
JournalJournal of pediatric surgery
Volume48
Issue number7
DOIs
StatePublished - Jul 1 2013

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Wilms Tumor
Adrenalectomy
Nephrectomy
Adrenal Glands
Neoplasms
Disease-Free Survival
Adrenal Insufficiency
Demography

Keywords

  • Adrenalectomy
  • Pediatric renal tumor
  • Wilms tumor

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Kieran, K., Anderson, J. R., Dome, J. S., Ehrlich, P. F., Ritchey, M. L., Shamberger, R. C., ... Davidoff, A. M. (2013). Is adrenalectomy necessary during unilateral nephrectomy for Wilms Tumor? A report from the Children's Oncology Group. Journal of pediatric surgery, 48(7), 1598-1603. https://doi.org/10.1016/j.jpedsurg.2013.04.019
Kieran, Kathleen ; Anderson, James R. ; Dome, Jeffrey S. ; Ehrlich, Peter F. ; Ritchey, Michael L. ; Shamberger, Robert C. ; Perlman, Elizabeth J ; Green, Daniel M. ; Davidoff, Andrew M. / Is adrenalectomy necessary during unilateral nephrectomy for Wilms Tumor? A report from the Children's Oncology Group. In: Journal of pediatric surgery. 2013 ; Vol. 48, No. 7. pp. 1598-1603.
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title = "Is adrenalectomy necessary during unilateral nephrectomy for Wilms Tumor? A report from the Children's Oncology Group",
abstract = "Purpose To determine whether performing adrenalectomy at the time of nephrectomy for unilateral Wilms tumor impacts clinical outcome. Methods We reviewed information on all patients enrolled on National Wilms Tumor Study-4 and -5. Data were abstracted on patient demographics, tumor characteristics, surgical and pathologic status of the adrenal gland, and patient outcomes. The primary endpoints were intraoperative spill and five-year event-free survival (EFS) in patients who did or did not undergo adrenalectomy. Results Of 3825 patients with complete evaluable data, the adrenal was left in situ in 2264 (57.9{\%}) patients, and was removed completely in 1367 patients (36.7{\%}) or partially in 194 patients (5.2{\%}). Of the adrenal glands removed, 68 (4.4{\%}) contained tumor. Adrenal involvement was more common in patients with stage 3 (9.8{\%}) than stage 2 disease (1.9{\%}; p < 0.0001). After controlling for stage and histopathology, five-year EFS was similar whether or not the adrenal gland was removed (p = 0.48), or involved with tumor (p = 0.81); however, intraoperative spill rates were higher in patients undergoing adrenalectomy (26.1{\%} vs 15.5{\%}, p < 0.0001), likely due to larger tumor size or technical factors. No patient had clinical evidence of adrenal insufficiency or tumor recurrence in the adrenal gland during follow-up (median 9.9 years). Conclusions Sparing the adrenal gland during nephrectomy for unilateral Wilms tumor was not associated with a higher incidence of intraoperative spill and was associated with a similar oncologic outcome, on a per-stage basis, with cases where the adrenal was removed. Thus, adrenalectomy should not be considered mandatory during radical nephrectomy for Wilms tumor.",
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Kieran, K, Anderson, JR, Dome, JS, Ehrlich, PF, Ritchey, ML, Shamberger, RC, Perlman, EJ, Green, DM & Davidoff, AM 2013, 'Is adrenalectomy necessary during unilateral nephrectomy for Wilms Tumor? A report from the Children's Oncology Group', Journal of pediatric surgery, vol. 48, no. 7, pp. 1598-1603. https://doi.org/10.1016/j.jpedsurg.2013.04.019

Is adrenalectomy necessary during unilateral nephrectomy for Wilms Tumor? A report from the Children's Oncology Group. / Kieran, Kathleen; Anderson, James R.; Dome, Jeffrey S.; Ehrlich, Peter F.; Ritchey, Michael L.; Shamberger, Robert C.; Perlman, Elizabeth J; Green, Daniel M.; Davidoff, Andrew M.

In: Journal of pediatric surgery, Vol. 48, No. 7, 01.07.2013, p. 1598-1603.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Is adrenalectomy necessary during unilateral nephrectomy for Wilms Tumor? A report from the Children's Oncology Group

AU - Kieran, Kathleen

AU - Anderson, James R.

AU - Dome, Jeffrey S.

AU - Ehrlich, Peter F.

AU - Ritchey, Michael L.

AU - Shamberger, Robert C.

AU - Perlman, Elizabeth J

AU - Green, Daniel M.

AU - Davidoff, Andrew M.

PY - 2013/7/1

Y1 - 2013/7/1

N2 - Purpose To determine whether performing adrenalectomy at the time of nephrectomy for unilateral Wilms tumor impacts clinical outcome. Methods We reviewed information on all patients enrolled on National Wilms Tumor Study-4 and -5. Data were abstracted on patient demographics, tumor characteristics, surgical and pathologic status of the adrenal gland, and patient outcomes. The primary endpoints were intraoperative spill and five-year event-free survival (EFS) in patients who did or did not undergo adrenalectomy. Results Of 3825 patients with complete evaluable data, the adrenal was left in situ in 2264 (57.9%) patients, and was removed completely in 1367 patients (36.7%) or partially in 194 patients (5.2%). Of the adrenal glands removed, 68 (4.4%) contained tumor. Adrenal involvement was more common in patients with stage 3 (9.8%) than stage 2 disease (1.9%; p < 0.0001). After controlling for stage and histopathology, five-year EFS was similar whether or not the adrenal gland was removed (p = 0.48), or involved with tumor (p = 0.81); however, intraoperative spill rates were higher in patients undergoing adrenalectomy (26.1% vs 15.5%, p < 0.0001), likely due to larger tumor size or technical factors. No patient had clinical evidence of adrenal insufficiency or tumor recurrence in the adrenal gland during follow-up (median 9.9 years). Conclusions Sparing the adrenal gland during nephrectomy for unilateral Wilms tumor was not associated with a higher incidence of intraoperative spill and was associated with a similar oncologic outcome, on a per-stage basis, with cases where the adrenal was removed. Thus, adrenalectomy should not be considered mandatory during radical nephrectomy for Wilms tumor.

AB - Purpose To determine whether performing adrenalectomy at the time of nephrectomy for unilateral Wilms tumor impacts clinical outcome. Methods We reviewed information on all patients enrolled on National Wilms Tumor Study-4 and -5. Data were abstracted on patient demographics, tumor characteristics, surgical and pathologic status of the adrenal gland, and patient outcomes. The primary endpoints were intraoperative spill and five-year event-free survival (EFS) in patients who did or did not undergo adrenalectomy. Results Of 3825 patients with complete evaluable data, the adrenal was left in situ in 2264 (57.9%) patients, and was removed completely in 1367 patients (36.7%) or partially in 194 patients (5.2%). Of the adrenal glands removed, 68 (4.4%) contained tumor. Adrenal involvement was more common in patients with stage 3 (9.8%) than stage 2 disease (1.9%; p < 0.0001). After controlling for stage and histopathology, five-year EFS was similar whether or not the adrenal gland was removed (p = 0.48), or involved with tumor (p = 0.81); however, intraoperative spill rates were higher in patients undergoing adrenalectomy (26.1% vs 15.5%, p < 0.0001), likely due to larger tumor size or technical factors. No patient had clinical evidence of adrenal insufficiency or tumor recurrence in the adrenal gland during follow-up (median 9.9 years). Conclusions Sparing the adrenal gland during nephrectomy for unilateral Wilms tumor was not associated with a higher incidence of intraoperative spill and was associated with a similar oncologic outcome, on a per-stage basis, with cases where the adrenal was removed. Thus, adrenalectomy should not be considered mandatory during radical nephrectomy for Wilms tumor.

KW - Adrenalectomy

KW - Pediatric renal tumor

KW - Wilms tumor

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UR - http://www.scopus.com/inward/citedby.url?scp=84880862065&partnerID=8YFLogxK

U2 - 10.1016/j.jpedsurg.2013.04.019

DO - 10.1016/j.jpedsurg.2013.04.019

M3 - Review article

VL - 48

SP - 1598

EP - 1603

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

IS - 7

ER -