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.

Surgery for adrenal cancer can be done using open approaches or minimally invasive (laparoscopic) options.

Open approach adrenal cancer surgery

For the open approach, the surgeon makes a cut through the front of the abdomen. This lets them 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.

Minimally invasive adrenal cancer surgery

The laparoscopic (minimally invasive) approach uses 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 on the side of the abdomen or on the back. 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.

Sometimes, the cancer can grow into the large vein that carries blood from the lower body to the heart (the inferior vena cava). 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.

Whether your surgeon will recommend a minimally invasive surgery, or an open surgery depends on the characteristics of the tumor and skills of the surgeon. Patients often recover faster from minimally invasive surgery because the incisions are smaller than in an open surgery.  Open surgery has been traditionally preferred for adrenal cancer surgery, but now doctors agree that the best surgical option is the one that completely removes the cancer without spilling any of its contents into the belly. Whether this can be accomplished through open or minimally invasive surgery depends on the patient’s specific case. It is important for patients with adrenal cancers to make sure their cancer care team has experience treating these kinds of tumors.  For suggestions on how to do this, see Where to Find Cancer Care