Surgical Procedures: Adrenalectomy for Cancer of the Adrenal Gland
What is an adrenalectomy and how is it performed?
Adrenocortical carcinoma is a rare cancer affecting the outer layer of the adrenal gland, which is a triangular shaped organ located above each kidney. A pheochromocytoma is a tumor located in a part of the adrenal gland called the adrenal medulla. In many cases, surgery to remove the adrenal gland is the first line treatment in these cancers.
To remove the affected adrenal gland(s), a surgeon will perform an adrenalectomy; this will remove one or both of the adrenal glands. Those with an increased risk of adrenocortical carcinoma include people with hereditary conditions such as Li-Fraumeni syndrome, Beckwith-Wiedmann syndrome, and Carney complex. Pheochromocytoma is very rare, but people with multiple endocrine neoplasia (MEN) are at increased risk.
Once a diagnosis of an adrenal cancer has been made, your healthcare provider will typically obtain additional testing to aid in determining the stage of the cancer. Cancers of the adrenal gland can metastasize (spread) to other parts of the body by the blood and lymph system. Procedures used for further evaluating the stage of cancer include blood and urine tests, and:
- Radiologic Imaging: Imaging such as a CAT scan (CT), magnetic resonance imaging (MRI) with gadolinium, MIBG scan, adrenal angiography, adrenal venography, cavagram and/or an ultrasound may be obtained.
- Adrenalectomy: Removal of the adrenal gland is known as an adrenalectomy. Currently, it is recommended that those with adrenal cancer undergo an open adrenalectomy, in which the surgeon accesses the adrenal gland through an incision in the abdomen or back. In some cases, the surgery may also be done laparoscopically. If the cancer has spread to other organs or tissues, the surgeon will attempt to remove the affected areas. At times, the inferior vena cava (vein coming from the heart) is affected by metastasized cancer; in this case, removing the tumor may require a heart-lung bypass pump. Other areas of the body, such as parts of the liver may also be affected, requiring removal of the affected areas. The tissue is then evaluated by a pathologist who will provide information used to stage the cancer.
What are the risks/side effects of having an adrenalectomy?
The risks of an adrenalectomy include:
- Wound infection
- Blood clots (deep vein thrombosis and/or pulmonary embolism)
- Lung infection
- Intestinal Ileus
- Other complications, such as stroke and heart attack, are rare
- Adrenal insufficiency
- Injury to surrounding organs and/or blood vessels
What is recovery like?
The hospital stay from an adrenalectomy is typically 3 to 5 days. Recovery from an adrenalectomy can take anywhere from 2 to 6 weeks.
Your medical team will discuss with you the medications you will be taking (blood clot and infection prevention, etc) and pain management.
Although your healthcare provider will discuss your particular activity restrictions while you are at home based on the extent of your surgical procedure, typically it is recommended that you:
- Avoid lifting anything over 5-10 pounds for 6 weeks
- Avoid rigorous activity for 4 weeks
- Avoid driving while on narcotic pain medications or if unable to perform normal daily tasks and activities
- Avoid showers until 2 days following surgery
- No tub bathing, swimming or incisional submersion in water for 1 to 2 weeks
Symptoms to report to your healthcare team include:
- Fever of 100.5 or higher
- Signs of a wound infection including redness, tenderness or incisional drainage
- Nausea, vomiting and/or chills
- Difficulty breathing
Care of Incision
You will be instructed on incisional care both before leaving the hospital and at home. Incisions should be kept clean and dry. Do not scrub with soap or a washcloth for 10 days and pat your incision dry after bathing.
How can I care for myself?
Depending on the extent of your surgery, you may need a family member or friend to help you with your daily tasks until you are feeling better and your medical team advises you to resume normal activity.
Be sure to take your medications as directed to prevent pain, infection, and/or constipation, and call your medical team with any concerning symptoms.
Deep breathing and relaxation are important to help with pain, keep lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to perform deep breathing and relaxation exercises several times a day in the first week, or whenever you notice you are particularly tense.
- A simple exercise to do on your own: While sitting (if allowed), close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.
- Find more relaxation exercises on OncoLink.
This hand-out provides general information only. Please be sure to discuss the specifics of your surgical plan and recovery with your surgeon.