Adrenalectomy is a surgical procedure used to remove all or part of the adrenal gland. This surgery is primarily employed to treat 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 lesions.
The main goal of this treatment is to control hormone overproduction, such as excess aldosterone or cortisol, by removing the affected tissue. Postoperative outcomes typically include significant improvement in hypertension, metabolic abnormalities, and a reduced risk of malignant tumor metastasis. However, patients require detailed preoperative assessment, including hormone testing and imaging studies, to ensure appropriate 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 suitable for large tumors or complex anatomical cases. The mechanism involves precise removal of adrenal tissue to block abnormal hormone sources—for example, in patients with Cushing's syndrome, removing the adrenal gland directly halts excess cortisol production.
In some cases, partial removal may be performed instead of total adrenalectomy 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 indicated 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 for surgery. The decision depends on tumor size, location, and overall health status.
The surgery is usually performed under general anesthesia. Laparoscopic adrenalectomy involves 2-3 small incisions (0.5-1 cm). The operation lasts approximately 2-4 hours, with an average blood loss of less than 100 ml. Total adrenalectomy involves complete removal of adrenal tissue, while partial removal preserves healthy tissue to maintain residual function.
Postoperative recovery typically requires hospitalization for 3-7 days, with continuous monitoring of electrolytes and hormone levels. Doctors may prescribe steroid replacement therapy, with dosages adjusted based on preoperative hormone levels, gradually normalizing over 6-12 months to meet physiological needs.
The primary benefits include:
The advantages of laparoscopic techniques include smaller incisions and less pain, with 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 post-surgery than with medication alone.
Immediate risks include:
Long-term risks include:
Preoperative preparations include:
Contraindications include: Uncorrected coagulation disorders, severe cardiopulmonary diseases intolerant to anesthesia, or tumors invading major blood vessels that cannot be safely resected. Postoperative monitoring for acute complications such as hypotension and hypoglycemia is essential.
Medication adjustments before and after surgery include:
Regarding interactions with radiotherapy, if the tumor is malignant, chemotherapy may be needed after surgery, but it should be avoided within 4 weeks post-operation to reduce complications.
Multicenter studies show that the 5-year survival rate for laparoscopic adrenalectomy in benign tumors reaches 98%, and 85% of patients with Cushing's syndrome achieve normalization of blood pressure within one year post-surgery. Imaging studies confirm that over 95% of adrenal tumors can be completely removed with surgery.
Compared to medication, surgery provides more durable control of primary aldosteronism symptoms, with a 5-year recurrence rate of up to 40% with medication, versus only 3% requiring further treatment after surgery.
Non-surgical options include:
Medication 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 depends on tumor benignity or malignancy, size, and overall health status.
Preoperative assessment includes blood tests, imaging scans, and cardiopulmonary evaluation to assess surgical risk. Patients should fast for 8 hours before surgery and adjust medications as instructed (e.g., anticoagulants). The surgeon will explain the surgical approach (traditional open or laparoscopic) and potential complications, ensuring the patient fully understands before signing consent.
Why is long-term hormone replacement therapy needed 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 is required to adjust dosages, and patients should not stop medication on their own.
Are there special dietary considerations after surgery?Initially, soft, easily digestible foods are recommended, avoiding strenuous activities that could induce bleeding. Long-term, a balanced intake of sodium (especially in cases of aldosterone deficiency) or blood pressure control (for primary aldosteronism) is necessary. Patients with diabetes should follow a low-carbohydrate diet planned with a nutritionist 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 the tumor invades blood vessels or the patient has had previous major abdominal surgery, open surgery may be preferred. The decision depends on tumor characteristics, patient condition, and surgeon experience, with detailed discussion needed.
How soon can normal life and work resume after surgery?Patients undergoing laparoscopic surgery typically resume light activities within 1-2 weeks and gradually return to normal work within 4-6 weeks. Open surgery requires 4-8 weeks for recovery. Activity restrictions should be followed until complete healing, including avoiding heavy lifting. Follow-up visits are recommended every 3 months to monitor adrenal hormone levels.
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