Surgery for adrenal cancer

The main treatment for adrenal cancer is removal of the adrenal gland, which is called an adrenalectomy. The surgeon will try to remove as much of the cancer as possible, including any areas of cancer spread. If nearby lymph nodes are enlarged, they will need to be removed and checked for cancer spread.

There are 2 major ways to remove the adrenal gland. One way is to remove the gland through an incision in the back, just below the ribs. This works well for small tumors, but it can be hard to see larger tumors well.

For most adrenal cancers, the surgeon makes the incision through the front of the abdomen. This lets the surgeon see the tumor more clearly and makes it easier to see if it has spread. It also gives the surgeon room to remove a large cancer that has spread (locally) to tissues and organs near the adrenal gland. For example, if the cancer has grown into the kidney, all or part of the kidney must also be removed. If it has grown into the muscle and fat around the adrenal gland, these tissues will need to be removed as well.

Sometimes, the cancer has grown into the inferior vena cava, the large vein that carries blood from the lower body to the heart. Complete removal of these cancers requires a very extensive operation to remove the tumor and preserve the vein. To remove the tumor from the vein, the surgeon may need to bypass the body's circulation by putting the patient on a heart-lung bypass pump like that used in heart surgery. If the cancer has grown into the liver, the part of the liver containing the cancer may need to be removed as well.

It is also possible to remove small adrenal tumors through a hollow lighted tube called a laparoscope. The laparoscope is a thin tube with a tiny video camera on the end that is inserted through a small surgical opening in the patient's side. Other instruments inserted through this tube or through other very small incisions are used to remove the adrenal gland. The main advantage of this method is that because the incisions are smaller, patients recover from surgery more quickly.

Although laparoscopic surgery is often used to treat adenomas, it often is not an option for treating larger adrenal cancers. That is because it is important to remove the tumor in one piece. To remove a large tumor with a laparoscope, the surgeon might have to break it up into small pieces first. Doing that raises the risk of the cancer spreading. Also, adrenal cancers that have grown into nearby tissues or lymph nodes can be hard to remove completely using laparoscopy.