Surgery to remove the adrenal gland is called an adrenalectomy. There are 2 major approaches to removing the adrenal gland. One way is to remove the gland through an incision in the back, just below the ribs. This works well for small tumors, but it can be hard to see larger tumors well. For most adrenal cortical carcinomas, the surgeon makes the incision through the front of the abdomen. This allows the surgeon to see the tumor more clearly and makes it easier to see if it has spread. It also allows room for the surgeon to remove a large cancer that has spread (locally) to tissues and organs near the adrenal gland. For example, if the cancer has grown into the kidney, the kidney must also be removed. If it has grown into the muscle and fat around the adrenal gland, these tissues will need to be removed as well.

Sometimes, the cancer has grown into the inferior vena cava, the large vein that carries blood from the lower body to the heart. Complete removal of these cancers requires a very extensive operation to remove the tumor and preserve the vein. To remove the tumor from the vein, the surgeon may need to bypass the body's circulation by putting the patient on a heart-lung bypass pump like that used in heart surgery. If the cancer has grown into the liver, a part of that organ containing the cancer may need to be removed as well.

It is also possible to remove some adrenal tumors through a hollow lighted tube called a laparoscope. The laparoscope is a thin tube with a tiny video camera on the end that is inserted through a small surgical opening in the patient's side. Other instruments inserted through this tube or through other very small incisions are used to remove the adrenal gland. The main advantage of this method is that because the incisions are smaller, patients recover from surgery more quickly. Although laparoscopic surgery is often used to treat adenomas, it may not be an option to treat some larger adrenal cancers. That is because when adrenal cancers have grown into nearby tissues or lymph nodes, it may be hard to remove the entire tumor using laparoscopy.