Surgery is the frontline treatment for cancers and other diseases of the adrenal gland. Normally, the entire affected adrenal gland is removed (adrenalectomy). If both adrenal glands are removed, patients will have to be on hormone therapy the rest of their lives.
Some carefully selected patients may be eligible for laparoscopic adrenalectomy, a minimally invasive surgical technique. Three or four one-centimeter incisions are made in the abdomen or the back to insert the laparoscope, which is a camera on the end of a long, slender tube, and tiny instruments that move nearby organs out of the way and excise the diseased adrenal gland. Surgeons watch their progress on video monitors mounted over the operation table. The adrenal gland is cut away from the kidney and placed in a plastic bag for removal through one of the surgical incisions. Patients who are obese or who have had prior abdominal surgery are good candidates for a retroperitoneal procedure, where incisions are made in the back rather than the abdomen.
Laparoscopic adrenalectomy usually takes about one to two hours, but might take longer for complex cases. Patients generally experience shorter hospital stays, less blood loss and shorter recovery times than with standard surgery techniques.
The best candidates for laparoscopic adrenalectomy:
Have benign tumors
Are diagnosed with pheochromocytoma, Cushing's Syndrome or adrenal adenomas
Have hormone overproduction in both adrenal glands (Cushing's disease)
Other candidates for laparoscopy include patients with isolated metastases to the adrenal gland from other sites (lung, breast, and melanoma).
Patients with suspected adrenocortical carcinoma are best treated with a standard, open surgical procedure to remove the tumor and other affected tissue. For patients with advanced adrenocortical carcinoma, chemotherapy with mitotane may be used to relieve symptoms from progressing disease. This type of cancer is not sensitive to radiation therapy.