Whether to remove the ipsilateral adrenal gland at the same time in radical kidney cancer surgery is always one of the debated issues among urologists. Different literature has different opinions, and the consensus in the industry is that the tumor in the middle and upper pole needs to remove the ipsilateral adrenal gland at the same time, so what should be done? The following is an analysis from the basic theories and fundamentals regarding the characteristics of line embryology, anatomy and malignant metastasis. The adrenal cortex originates from the embryonic lateral plate mesoderm. During the 5th-6th week of embryonic development, the germinal epithelial cells located at the root of the mesentery near the head of the mesonephros begin to proliferate and gradually migrate outside the posterior peritoneum, where they develop into the primitive cortex. The adrenal medulla originates from the ectodermal cells of the neural crest, and a portion of the neural crest ectodermal cells differentiate into chromophores, which join with and enter the developing cortical cells to form the adrenal medulla. During embryonic development, the adult permanent kidney is derived from the posterior kidney, which originates from the mesodermal mesoderm. At the beginning of the 5th week of the human embryo, the posterior kidney begins to form while the mesoderm is still developing, and at the 11th-12th week, the posterior kidney begins to produce urine. It is evident from the embryonic development that the kidney and the adrenal gland have different tissue origins and developmental processes, as evidenced by the absence of ectopic adrenal glands in patients with ectopic kidneys. The adrenal vein system differs between the left and right sides, with all of the left adrenal veins converging into the left renal vein; most of the right adrenal veins converge into the right posterior wall of the inferior vena cava, with a few converging into the right paracentral hepatic vein and the subphrenic vein, respectively. In addition, there may be companion veins with the same name as the superior, middle and inferior adrenal arteries, which inject into the subphrenic, adrenal and renal veins, respectively. The renal veins return directly to the inferior vena cava, most of the right renal veins have no geniculate branches, and the left renal veins receive blood back from the adrenal veins, the subphrenic veins, the gonadal veins, and the lumbar veins. The renal peritoneal veins interoperate with the small veins of the perirenal tissues and form an accessory network with the perirenal fatty internal veins, which are divided into two groups: major and accessory. The major venous components are the upper and lower periprosthetic veins. The superior peritoneal vein is located between the kidney and the adrenal gland and returns to the adrenal vein. The inferior peritoneal veins originate from the lower pole of the kidney and return to the gonadal veins or branches of the renal veins. The lymphatic vessels of the adrenal glands originate from the intraglandular lymphatic plexus and drain in a vascular direction, accompanying the adrenal arterial lymphatics to the abdominal lymph nodes and inferior vena cava lymph nodes, and the adrenal venous lymphatics to the lumbar lymph nodes. In addition, there is a common subplasmatic lymphatic plexus on the surface of the kidney and adrenal glands that eventually infuses the lumbar lymph nodes. The renal lymphatic vessels are divided into two parts: first, the renal lymphatic plexus surrounding the renal cortex and medullary tubules is arranged around the renal vessels, especially the renal veins, and eventually terminates in the lymph nodes surrounding the renal vessels and the lymph nodes of the abdominal aorta along with the renal veins outside the renal hilum. The second is the renal peritoneal lymphatic vessels, which are divided into superficial and deep groups. The superficial lymphatic system is located beneath the renal fascia and peritoneum and drains lymphatic fluid to the deep lymphatic system beneath the renal peritoneum and into the lymphatic vessels of the renal parenchyma. The location of the adrenal glands and the kidneys are adjacent to each other, with the adrenal glands located within the perinephric fascial capsule, beneath the bilateral adrenal glands adjacent to the medial aspect of the suprarenal poles, which are separated by perinephric fat. From the above, in general, the blood flow and lymphatic fluid of kidney do not enter the adrenal tissue directly, and the embryonic development is not homologous, so there is no direct and inevitable connection between the two, except for the close location. The most common metastatic sites of kidney tumor are lung, bone and liver, but not the adrenal gland. Therefore, it is not advisable to routinely remove the adrenal gland for kidney cancer, but with the current advanced imaging examination, the adrenal gland without preoperative abnormalities can be preserved as much as possible.