Editing Management of Localized and Locally Advanced Disease (section)

==== Adrenalectomy ====

* '''The ipsilateral adrenal gland should be preserved at the time of the nephrectomy provided it appears normal on imaging and there is no sign of direct tumour invasion'''
** Traditionally, radical nephrectomy included the ipsilateral adrenal gland and complete regional lymphadenectomy from the crus of the diaphragm to the aortic bifurcation, as described by Robson and colleagues in 1969 for management of renal malignancy.
** '''Overall incidence of adrenal metastasis is <5% and removal of the adrenal gland, when not involved by tumor, has not been shown to improve survival of patients with renal cancer.'''
** CT has 99.4% specificity and 99.4% negative predictive value for detecting adrenal involvement

===== Indications =====

====== AUA ======
* '''2021 AUA (2):'''
** '''Absolute (1):'''
**# '''If preoperative imaging or intraoperative inspection suggests metastasis or adrenal enlargement'''
**#* One exception is when patient has a well-characterized adenoma, which may not mandate surgical excision
** '''Relative (1):'''
**# '''Locally advanced features are identified preoperatively or during exploration and the gland is in close proximity to the tumour'''
**#* Adrenal may be spared in this setting if the contralateral adrenal gland is absent and the ipsilateral gland demonstrates normal morphology and no malignant involvement.

====== Other sources (7): ======
# Advanced stage (cT3-4)
# Large upper pole tumors (>7cm) when the surgical plane between the kidney and adrenal gland may be compromised
# Extrarenal tumor extension
# Large tumor size (>10 cm)
# Diffuse involvement by tumor
# Tumor thrombus
# Lymphadenopathy and regional metastasis