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Adrenal Surgery

Indications for Adrenalectomy

  • Malignant Adrenal Tumour

    • Adrenocortical Cancer (Primary Cancer)

    • Metastatic Cancer to Adrenal (Secondary Cancer)

      • Colorectal Cancer

      • Melanoma

      • Renal Cancer

      • Lung Cancer 

      • Breast Cancer

 

  • Suspicion of cancer

    • Tumour size > 4 cm

    • Suspicious CT features

    • Intense uptake on PET scan

    • Rapid Growth of a tumour

 

  • Functioning Adrenal Tumour (Hormone secreting)

    • Adrenaline (Phaeochromocytoma)

    • Cortisol (Cushing's syndrome)

    • Aldosterone (Conn's syndrome)

Laparoscopic Adrenal Surgery

The adrenal glands are in a remote position towards the back of the abdomen, sited a the apex of the kidney and surrounded by other organs (RIGHT: Liver, IVC, Colon, Diaphragm, Kidney and LEFT: Pancreas, Spleen, Aorta, Colon, Diaphragm, Kidney). Traditionally this required a large open incision to facilitate safe surgery. Laparoscopic or key hole surgery has revolutionalised adrenal surgery. Adrenalectomy can now be achieve through 3 or 4 small (1 cm) incisions. This significantly reduces post-operative pain, reduced length of hospital stay and reduces pain.

 

Types of laparoscopic surgery offered:

 

  • Transperitoneal

  • Retroperitoneal

  • Hand-port assisted

 

There is no one perfect way of performing adrenal surgery. These different techiniques are complementary and individually tailored to the patient and their tumour.

Cortical Sparing Adrenal Surgery

Removing one adrenal gland will not normally cause lasting hormone imbalance as long as the other adrenal gland is normal. However occasionally patients will have pathology in both adrenals and removing both glands will cause significant hormonal imbalance (Addison's disease) requiring lifelong replacement and monitoring. In patients with bilateral tumours, cortical sparing adrenalectomy leaves some normal adrenal tissue (usually a 20% remnant) is sufficient to avoid Addison's disease.

 

Conditions associated with bilateral adrenal pathology:

 

  • Hereditary phaeochromocytomas (MEN 2 syndrone, von Hipple Lindau syndrome)

  • Bilateral aldosterone secreting tumours

  • Bilateral adrenal metastases

Open Adrenal Surgery

Whilst the majority of adrenal tumours are suitable for laparoscopic surgery, there are certain tumours that are more safely removed through a larger incision on the abdomen. Adrenocortical Cancers are often very large at the time of diagnosis and this tumour is usually aggressive, highly vascular and infiltrates surrounding tissues. Tumour breach is associated with poor outcome and radical surgery is often required. This is the main indication for open surgery. 

 

Open surgery is sometimes also required for:

 

  • Suspicion of adrenocortical cancer

  • Large metastasis to the adrenal

  • Large benign adrenal tumours

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