Question

Radical nephrectomy for renal cell carcinoma does NOT involve excision of

• A. Kidney with Gerota's fascia
• B. Pre- and para-aortic lymph nodes
• C. Adrenal gland
• D. Complete ureter with a cuff of urinary bladder

Hint:

Think about which structure is only removed selectively, not as a routine step, in current practice.

Answer 1

The Correct Option is C

Step 1: Understanding the Question:
The question tests the standard extent of dissection in a radical nephrectomy done for renal cell carcinoma, and asks which structure is not part of the standard specimen.

Step 2: Key Concept or Approach:
Classic (Robson) radical nephrectomy removes the kidney en bloc within Gerota's fascia, along with regional (hilar and pre-/para-aortic) lymph nodes and early ligation of the renal vessels. Ipsilateral adrenalectomy was traditionally included, but evidence accumulated showing the adrenal gland is rarely involved by RCC unless the tumour is large, upper-pole, or adrenal involvement is seen on imaging, so routine adrenalectomy is no longer considered a required part of the operation.

Step 3: Working Through the Options:
Kidney with Gerota's fascia is always excised — this is the core of the operation. Pre- and para-aortic lymph nodes are removed as part of the regional lymphadenectomy. Complete ureter with a cuff of urinary bladder is taken along with the specimen when the ureter is transected close to the bladder. Adrenal gland removal, by contrast, is now selective rather than routine, since studies have shown no survival benefit from removing a grossly normal adrenal gland — this makes it the structure that is NOT always part of radical nephrectomy.

Step 4: Conclusion:
The adrenal gland is the structure whose excision is not a mandatory part of radical nephrectomy for renal cell carcinoma.