Abstract
Objective
Laparoscopic adrenalectomy (LA) has become the gold standard technique for almost all the adrenal masses, but several Authors still debate about LA in pheochromocytoma.
Background
The purpose of this study was to compare feasibility and safety of LA for pheo and analyze the results relative to LA for incidentaloma, Conn’s disease and Cushing’s disease.
Methods
Between January 1994 and March 2006, 167 LAs were carried out in 160 consecutive patients at our Department and 46 of them were affected by pheo, 60 by Conn’s disease, 34 by adrenal incidentaloma and 20 by Cushing’s disease.
The following parameters were statistically analysed
Side and size of lesion, conversion to open adrenalectomy (OA), operating time, length of hospital stay, intraoperative blood pressure variations, blood loss, blood transfusion, need for postoperative analgesia, resumption of oral nutrition and postoperative complications.
Results
Successful LA was performed in 159 out of 167 cases (95.2%). Significant statistical advantages were observed for pheo, even if its average size was larger (p > 0.001), in terms of average operating time (p < 0.001), average length of hospital stay (p < 0.001), average intraoperative blood loss (p > 0.001), postoperative analgesia (p < 0.001), oral nutrition (p < 0.001). LA for patients with Cushing’s disease (average length of hospital stay and intraoperative blood loss, p < 0.023 and p > 0.002 respectively) and with adrenal incidentaloma (intraoperative blood loss p < 0.009) seems to be a more challenging procedure.
Conclusion
The evaluation of this relatively large monoinstitutional experience suggests that LA could be considered the most suitable method for removing pheochromocytoma. This tumour tends to be larger than most functional cortical adenomas, neverthless it allows even a significant reduction in operating time with a faster recovery.
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References
Brunt ML (2006) Minimal access adrenal surgery. Surg Endosc 20: 351–361
Cheah WK, Clark OH, Horn JK, Siperstein AE, Duh QY (2002) Laparoscopic adrenalectomy for pheochromocytoma. World J Surg 26(8): 1048–1051
Fernandez Cruz L, Saez A, Taura P, Sabater L, Astudillo E, Fontanals J (1998) Helium and carbon dioxide pneumoperitoneum in patients with pheochromocytoma undergoing laparoscopic adrenalectomy. World J Surg 22: 1250–1255
Flavio Rocha M, Faramarzi-Roques R, Tauzin-Fin P, Vallee V, Leitao de Vasconcelos PR, Ballanger P (2004) Laparoscopic surgery for pheochromocytoma. Eur Urol 45(2): 226–232
Goldstein RE, O’Neill JA, Holcomb GW (1999) Clinical experience over 48 years with pheochromocytoma. Ann Surg 229: 755–764
Kalady MF, McKinlay R, Olson JA Jr, Pinheiro J, Lagoo S, Park A, Eubanks WS (2004) Laparoscopic adrenalectomy for pheochromocytoma. A comparison to aldosteronoma and incidentaloma. Surg Endosc 18(4): 621–625
Kercher KW, Novitsky YW, Park A, Matthews BD, Litwin DE, Heniford BT (2005) Laparoscopic curative resection of pheochromocytomas. Ann Surg 241(6): 919–926
Kercher KW, Park A, Matthews BD, Rolband G, Sing RF, Heniford BT (2002) Laparoscopic adrenalectomy for pheochromocytoma. Surg Endosc 16: 100–102
Kim AW, Quiros RM, Maxhimer JB (2004) Outcome of laparoscopic adrenalectomy for pheochromocytomas vs aldosteronomas. Arch Surg 139: 526–531
Mobius E, Nies C, Rothmund M (1999) Surgical treatment of pheochromocytoma: laparoscopic or conventional? Surg Endosc 13: 35–39
Shen WT, Kebebew E, Clark OH, Duh QY (2004) Reasons for conversion from laparoscopic to open or hand-assisted adrenalectomy: review of 261 laparoscopic adrenalectomies from 1993 to 2003. World J Surg 28(11): 1176–1179
Thomson BN, Moulton CA, Davies M, Banting SW (2004) Laparoscopic adrenalectomy for phaeochromocytoma:with caution. ANZ J Surg 74(6): 429–433
Toniato A, Piotto A, Pagetta C, Bernante P, Pelizzo MR (2001) Technique and results of laparoscopic adrenalectomy. Langenbecks Arch Surg 386(3): 200–203
Walz MK, Petersenn S, Koch JA, Mann K, Neumann HP, Schmid KW (2005) Endoscopic treatment of large primary adrenal tumours. Br J Surg 92(6): 719–723
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Toniato, A., Boschin, I., Bernante, P. et al. Laparoscopic adrenalectomy for pheochromocytoma: is it really more difficult?. Surg Endosc 21, 1323–1326 (2007). https://doi.org/10.1007/s00464-006-9190-8
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DOI: https://doi.org/10.1007/s00464-006-9190-8