Adrenalectomy is a surgical procedure used to remove all or part of the adrenal gland. This surgery is primarily indicated for treating adrenal tumors, hormone excess disorders, or severe complications caused by adrenal dysfunction. The surgical approaches include laparoscopic surgery and traditional open surgery, selected based on the patient's condition and the extent of adrenal pathology.
The main goal of this treatment is to control hormone overproduction, such as excess aldosterone or cortisol, by removing the diseased tissue. Postoperative outcomes often include significant improvement in hypertension, metabolic abnormalities, and a reduced risk of malignant tumor metastasis. However, patients require thorough preoperative evaluation, including hormone testing and imaging studies, to confirm surgical indications.
Adrenalectomy mainly divides into two types: laparoscopic adrenalectomy and open surgery. Laparoscopic surgery involves small incisions (0.5-1 cm) through which an endoscope and instruments are inserted, offering advantages of minimal trauma and quick recovery. Open surgery is reserved for cases with large tumors or complex anatomy. The mechanism involves precise removal of adrenal tissue to block the source of abnormal hormones, such as in Cushing's syndrome, where removing the adrenal gland directly halts excess cortisol production.
In some cases, partial adrenalectomy may be performed to preserve residual adrenal function. After successful surgery, patients need long-term monitoring of adrenal hormone levels and may require hormone replacement therapy to compensate for deficiencies in aldosterone or cortisol.
This surgery is mainly suitable for the following conditions:
Additionally, patients with Conn's syndrome unresponsive to medication or those with severe complications such as cardiac hypertrophy caused by hormone excess are also candidates. Surgeons will determine the necessity of surgery based on tumor size, location, and overall health status.
The surgery is usually performed under general anesthesia. Laparoscopic procedures require 2-3 small incisions (0.5-1 cm). The operation lasts approximately 2-4 hours, with an average blood loss of less than 100 milliliters. Total adrenalectomy involves complete removal of the adrenal gland, while partial removal preserves healthy tissue to maintain residual function.
Postoperative recovery typically involves 3-7 days of hospitalization, with continuous monitoring of electrolytes and hormone levels. Doctors may prescribe steroid replacement therapy, with doses adjusted based on preoperative hormone levels, gradually tapering over 6-12 months to meet normal physiological needs.
The primary benefits include:
The advantages of laparoscopic techniques include smaller incisions, less pain, and an average hospital stay reduced by 40% compared to traditional surgery. Long-term follow-up shows that 90% of patients with primary aldosteronism achieve better blood pressure control postoperatively than with medication alone.
Potential immediate risks include:
Long-term risks include:
Preoperative preparations include:
Contraindications include: Uncorrected coagulopathies, severe cardiopulmonary diseases intolerant to anesthesia, and cases where tumors invade major blood vessels, making safe resection impossible. Postoperative monitoring for acute complications such as hypotension and hypoglycemia is essential.
Medication adjustments before and after surgery are necessary:
Regarding interactions with radiotherapy, if the tumor is malignant, chemotherapy may be needed after surgery, but it should be avoided within 4 weeks postoperatively to reduce complications.
Multicenter studies show that laparoscopic adrenalectomy has a 98% 5-year survival rate in benign tumors, and 85% of patients with Cushing's syndrome achieve normalized blood pressure within 1 year post-surgery. Imaging studies confirm that over 95% of adrenal tumors can be completely removed surgically.
Compared to medication, surgery provides a more durable control of primary aldosteronism symptoms, with a 5-year recurrence rate of 40% with medication versus only 3% requiring re-treatment after surgery.
Non-surgical options include:
Drug therapy is suitable for high-risk surgical patients but has limited long-term efficacy. Radiotherapy may take 6-12 months to show effects and is less effective for functional tumors. The choice of alternative treatment depends on tumor benignity or malignancy, size, and overall health status.
Patients should undergo detailed examinations, including blood tests, imaging scans, and cardiopulmonary assessments to evaluate surgical risks. Fasting for 8 hours before surgery and adjusting medications such as anticoagulants as per medical advice are required. Surgeons will explain the surgical approach (traditional open or laparoscopic) and potential complications, ensuring informed consent.
Why do I need to take hormone replacement therapy long-term after surgery?After adrenalectomy, patients may lose the natural secretion of cortisol or aldosterone, leading to adrenal insufficiency. Doctors prescribe steroids or mineralocorticoids to maintain metabolic and electrolyte balance. Regular follow-up and dose adjustments are necessary; patients should not stop medication on their own.
Are there special dietary considerations after surgery?Initially, soft and easily digestible foods are recommended, avoiding strenuous activities that could cause bleeding. Long-term, a balanced intake of sodium (especially in cases of aldosterone deficiency) or blood pressure control (for primary aldosteronism) is advised. Patients with diabetes should follow a low-carbohydrate diet and monitor blood glucose levels.
What are the criteria for choosing between laparoscopic and open surgery?Laparoscopic surgery is suitable for tumors smaller than 6 cm, without extensive metastasis, and in patients without severe complications. If tumors invade blood vessels or previous abdominal surgeries have been performed, open surgery may be necessary. The decision depends on tumor characteristics, patient condition, and surgeon experience, discussed thoroughly with the medical team.
How long does it take to recover and return to normal life and work?Patients undergoing laparoscopic surgery typically resume light activities within 1-2 weeks, with gradual return to normal work in 4-6 weeks. Open surgery requires 4-8 weeks for recovery. Recovery time varies by individual; heavy lifting should be avoided until fully healed. Follow-up visits are recommended within 3 months to monitor adrenal hormone levels.
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