Surgery for Adrenal Cancer

The main treatment for adrenal cancer is removal of the adrenal gland, an operation 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 also will need to be removed and checked for cancer spread.

One way to remove the adrenal gland is 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.

More often, 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 grown into 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 can grow into the inferior vena cava, the large vein that carries blood from the lower body to the heart. If this is the case, it requires a very extensive operation to remove the tumor completely 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 might need to be removed, too.

It is also possible to remove some small adrenal tumors through a thin hollow, lighted tube (with a tiny video camera on the end) called a laparoscope. Instead of a large incision in the skin to remove the tumor, several small ones are made. The surgeon inserts the laparoscope through one of them to look inside the belly. Then, other instruments inserted through this tube or through other 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 used to treat adrenal adenomas (benign tumors), it often is not an option for treating larger adrenal cancers. This is because it's important to remove the tumor in one piece whenever possible. 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. Adrenal cancers that have grown into nearby tissues or lymph nodes can also be hard to remove completely using laparoscopy.