Safety of Laparoscopic Adrenalectomy in Patients with Large Pheochromocytomas: A Single Institution Review

Abstract

Background

Laparoscopic adrenalectomy is the procedure of choice for small adrenal tumors, but some concerns have been voiced when this approach is adopted for larger tumors and pheochromocytomas. The aim of this study was to examine the results of the laparoscopic resection of large pheochromocytomas.

Methods

A retrospective review of adrenalectomies performed for adrenal pheochromocytomas >6 cm in diameter. We compiled and analyzed the early operative complications, histologic findings, and cure rates with a minimum of 1 year of follow-up after surgery.

Results

From 1996 to 2005, a total of 445 laparoscopic adrenalectomies were performed in our institution using the anterolateral transperitoneal approach. From this series we identified 18 procedures for pheochromocytomas with an average diameter on imaging of 78.2 mm (range 60–130 mm). All patients were rendered safe with a standard departmental protocol involving calcium-channel blockade initiated at least 2 weeks prior to surgery. The average peak intraoperative blood pressure was 187 mmHg. Capsular disruption occurred in two cases. One patient required an intraoperative blood transfusion due to intraoperative blood loss. No immediate conversions to an open procedure were required, but one patient underwent a delayed laparotomy for hematoma formation. Histologically, four of the adrenal tumors displayed evidence of vascular invasion. Biochemical cure was achieved in all patients after a median follow-up of 58 months (16–122 months).

Conclusions

Laparoscopic adrenalectomy appears to be a safe and effective approach for large pheochromocytomas when no preoperative or intraoperative evidence of local invasion is present.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    Dudley NE, Harrison BJ (1999) Comparison of open posterior versus transperitoneal laparoscopic adrenalectomy. Br J Surg 178:50–53

    Google Scholar 

  2. 2.

    Jacobs JK, Goldstein RE, Geer RJ (1997) Laparoscopic adrenalectomy: a new standard of care. Ann Surg 225:495–501

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Gagner M, Pomp A, Heniford BT, et al. (1997) Laparoscopic adrenalectomy: lessons learned from 100 consecutive procedures. Ann Surg 226:238–246

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Kercher KW, Novitsky YW, Park A, et al. (2005) Laparoscopic curative resection of pheochromocytomas. Ann Surg 241:919–926

    PubMed  Article  Google Scholar 

  5. 5.

    Wilhelm SM, Prinz RA, Barbu AM, et al. (2006) Analysis of large versus small pheochromocytomas: operative approaches and patient outcomes. Surgery 140:553–559

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Taïeb D, Sebag F, Hubbard JG, et al. (2004) Does iodine–131 meta-iodobenzylguanidine (MIBG) scintigraphy have an impact on the management of sporadic and familial phaeochromocytoma? Clin Endocrinol (Oxf) 61:102–108

    Article  Google Scholar 

  7. 7.

    Gagner M, Lacroix A, Bolte E (1992) Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 327:1033

    PubMed  CAS  Article  Google Scholar 

  8. 8.

    Henry JF, Sebag F, Iacobone M, et al. (2002) Lessons learned from 274 laparoscopic adrenalectomies. Ann Chir 127:512–519

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Henry JF, Defechereux T, Raffaelli M, et al. (2000) Complications of laparoscopic adrenalectomy: results of 169 consecutive procedures. World J Surg 24:1342–1346

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Shen WT, Kebebew E, Clark OH, et al. (2004) Reasons for conversion from laparoscopic to open or hand-assisted adrenalectomy: review of 261 laparoscopic adrenalectomies from 1993 to 2003. World J Surg 28:1176–1179

    PubMed  Article  Google Scholar 

  11. 11.

    Ito Y, Obara T, Yamashita T, et al. (1996) Pheochromocytomas: tendency to degenerate and cause paroxysmal hypertension. World J Surg 20:923–926

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Atuk NO, Teja K, Mondzelewski P, et al. (1977) Avasucular necrosis of pheochromocytoma followed by spontaneous remission. Arch Intern Med 137:1073–1075

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Crout JR, Sjoerdsma A (1964) Turnover and metabolic of catecholamines in patients with pheochromocytoma. J Clin Invest 43:94–102

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Fernandez-Cruz L, Taura P, Saenz A, et al. (1996) Laparoscopic approach to pheochromocytoma: hemodynamic changes and catecholamine secretion. World J Surg 20:762–768

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Flavio Rocha M, Faramarzi-Roques R, Tauzin-Fin P, et al. (2004) Laparoscopic surgery for pheochromocytoma. Eur Urol 45:226–232

    PubMed  Article  Google Scholar 

  16. 16.

    Bravo EL, Tarazi RC, Gifford RW, et al. (1979) Circulating and urinary catecholamines in pheochromocytoma: diagnostic and pathophysiologic implications. N Engl J Med 301:682–686

    PubMed  CAS  Article  Google Scholar 

  17. 17.

    Bravo EL, Tagle R (2003) Pheochromocytoma: state-of-the-art and future prospects. Endocr Rev 24:539–553

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Thompson LD (2002) Pheochromocytoma of the adrenal gland scaled score (PASS) to separate benign from malignant neoplasms: a clinicopathologic and immunophenotypic study of 100 cases. Am J Surg Pathol 26:551–566

    PubMed  Article  Google Scholar 

  19. 19.

    Goldstein RE, O’Neill JA Jr, Holcomb GW 3rd, et al. (1999) Clinical experience over 48 years with pheochromocytoma. Ann Surg 229:755–764

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Shen WT, Sturgeon C, Clark OH, et al. (2004) Should pheochromocytoma size influence surgical approach? A comparison of 90 malignant and 60 benign pheochromocytomas. Surgery 136:1129–1137

    PubMed  Article  Google Scholar 

  21. 21.

    Van Heerden JA, Roland CF, Carney JA, et al. (1990) Long-term evaluation following resection of apparently benign pheochromocytoma(s)/paraganglioma(s). World J Surg 14:325–329

    PubMed  Article  Google Scholar 

  22. 22.

    Meng MV, Koppie TM, Duh QY, et al. (2001) Novel method of assessing surgical margin status in laparoscopic specimens. Urology 58:677–681

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Scott HW Jr, Halter SA (1984) Oncologic aspects of pheochromocytoma: the importance of follow-up. Surgery 96:1061–1066

    PubMed  Google Scholar 

  24. 24.

    Harrison TS, Freier DT, Cohen EL (1974) Recurrent pheochromocytoma. Arch Surg 108:450–454

    PubMed  CAS  Google Scholar 

  25. 25.

    Palazzo FF, Sebag F, Sierra M, et al. (2006) Long-term outcome following laparoscopic adrenalectomy for large solid adrenal cortex tumors. World J Surg 30:893–898

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Giuseppe Ippolito.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ippolito, G., Palazzo, F.F., Sebag, F. et al. Safety of Laparoscopic Adrenalectomy in Patients with Large Pheochromocytomas: A Single Institution Review. World J Surg 32, 840–844 (2008). https://doi.org/10.1007/s00268-007-9327-5

Download citation

Keywords

  • Laparoscopic Approach
  • Esmolol
  • Adrenal Tumor
  • Laparoscopic Adrenalectomy
  • Adrenal Vein