Adrenal Gland Surgery
The adrenals are two small glands, located on one atop of each of the kidneys, that have an important hormonal function, including production of adrenaline and noradrenaline. Disorders of the adrenal glands include over- or underactivity, or cancer growth.
Surgery is an important option for addressing overactive adrenal glands. This condition can sometimes be caused by an abnormality of the glands itself. Most often, this is due to nonmalignant tumors of the gland tissue called adrenal adenomas. (Cancerous tumors can also be a cause, but they are much less common.) Adrenal gland surgery to treat this condition means removing one or both adrenal glands. Our surgeons can often minimize the invasiveness of these operations by using a laparoscopic approach.
For more on surgery for adrenal gland tumors, see also the Division of Surgical Oncology.
Surgery for Cancer of the Adrenal Gland
The adrenal glands are two small organs that sit one atop each of the kidneys and produce epinephrine (adrenalin) and norepinephrine and other essential hormones such as cortisone and aldosterone. Cancers of the adrenal gland (adrenal carcinomas or pheochromocytomas) are rare. Benign tumors of the adrenal gland, such as adrenal adenomas, are more common and may be functional (causing significant hormonal imbalance that is symptomatic) or nonfunctional. Functional tumors require resection. Nonfunctional tumors greater than four centimeters in size should be considered for resection.
The surgeon evaluates the tumor and determines whether the patient is a candidate for surgery based on a complete history, examination, and blood tests, as well as CT and MR imaging and, sometimes, vascular studies. If an adrenal gland develops a primary tumor causing overproduction of hormones or an adrenal mass that causes symptoms, the adrenal gland must be removed. The surgeon will want to determine if the tumor has involved any of the critical nearby organs or structures, including the diaphragm, liver, kidney, spleen or pancreas.
An adrenalectomy, or resection of the entire adrenal gland, is the most effective way of treating adrenal tumors. If there are indications that the cancer has spread locally, the surgeon will also remove the tissue immediately surrounding the gland, including the lymph nodes.
Pheochromocytomas are adrenal tumors that secrete adrenalin. They need preoperative medical treatment prior to resection.
After surgery, patients can live with one adrenal gland, without suffering any negative results. Those who have both glands removed will have to take hormone supplements for the rest of their lives.
This minimally invasive approach to surgery is the procedure of choice whenever patients are eligible for it. Using this technique, the surgeon can remove the adrenal gland through three or four incisions of approximately ½ inch. The patient is under general anesthesia and the surgeon views the adrenal gland through a special endoscope, introducing instruments through the other punctures to cut away and remove the gland.
Patients may leave the hospital in one or two days. They experience less postoperative pain and a faster return to normal activity, compared with open surgical resection. Laparoscopic adrenalectomy is best for smaller, nonmalignant tumors and those that produce hormones.
Some patients may not be candidates for laparoscopy, due to such factors as type of tumor, obesity, prior abdominal surgery that has left dense scar tissue, or other factors. In addition, during some cases of attempted laparoscopic adrenalectomy, the surgical team may have trouble seeing the adrenal gland, the patient may experience bleeding, or the tumor may be larger than expected in size. In these cases, the team may convert to a traditional, open surgical procedure.
In open adrenalectomy, the surgeon uses a conventional incision of at least six inches in the abdomen, flank, or back to directly access the adrenal glands. For removing small tumors, an incision in the back, just below the ribs works best. But in most cases, the surgeon must make the incision in the front of abdomen. This permits the surgical team to better visualize the tumor and assess whether it has spread. Abdominal access permits removal of large tumors or cancers that have spread to other nearby organs (such as the kidney) or other tissue. If the tumor has grown into the large vein that transports blood from the lower body to the heart (the vena cava), then more a complex operation may be undertaken, requiring heart-lung circulation, as in heart surgery. Open adrenalectomy can require a hospital stay of the better part of a week, followed by several weeks for full recovery.
Sometimes an adrenal cancer may be too advanced or widespread for complete removal, and curative surgery is not possible. However, some types of surgical treatment can still be beneficial in addressing the resulting symptoms.
If an adrenal tumor has invaded surrounding organs, and so cannot be fully removed, the surgeon may operate to debulk the tumor, removing as much tumor as possible. This can decrease excessive hormone production and reduce pain from the tumor.