Editing Management of Localized and Locally Advanced Disease (section)

===== 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