Surgical Procedures: Adrenalectomy for Cancer of the Adrenal Gland

What is an adrenalectomy and how is it done?

Adrenocortical carcinoma is a rare cancer affecting the outer layer of the adrenal gland. The adrenal glands are shaped like triangles and are found 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. This surgery is called an adrenalectomy.

During an adrenalectomy, your surgeon will remove one or both of your 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 higher risk. 

Once adrenal cancer has been diagnosed, your healthcare provider will often order more testing to figure out the stage of your cancer. Cancers of the adrenal gland can metastasize (spread) to other parts of the body by the blood and lymph system. For further testing and staging, you will have blood and urine tests, as well as:

• Imaging: Tests such as CAT scan (CT), magnetic resonance imaging (MRI) with contrast, MIBG scan, adrenal angiography, adrenal venography, and/or an ultrasound may be done.
• Adrenalectomy: One or both adrenal glands are removed. In an open adrenalectomy, the surgeon removes the adrenal gland through an incision (cut) in the abdomen (belly) or back. This can also be done laparoscopically. This is when the surgeon inserts tools through a few small incisions. 
• If the cancer has spread to other organs or tissues, the surgeon may try to remove the areas. At times, the inferior vena cava (vein coming from the heart) is affected by cancer. Removing these tumors may require a heart-lung bypass pump. Other areas of the body, such as parts of the liver may be affected, which will be removed when possible. The tissue is then looked at by a pathologist who will stage the cancer.

Your adrenal glands are involved in making hormones that help your body work. Talk to your provider about any hormone levels that will need to be monitored before and after surgery. You may need to take hormone replacement medications. 

What are the risks/side effects of having an adrenalectomy?

The risks of an adrenalectomy include:

• Wound infection.
• Bleeding.
• Blood clots (deep vein thrombosis and/or pulmonary embolism).
• Lung infection.
• Intestinal Ileus.
• 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.

After surgery, it is often 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.
• Signs of a wound infection include redness, tenderness, or incisional drainage.
• Nausea, vomiting, and/or chills.
• Lightheadedness.
• Difficulty breathing.

How do I care for my incision?

You will be instructed on incisional care both before leaving the hospital and at home. Incisions should be kept clean and dry. 

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection, and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation. 

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.