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Surgery for Pheochromocytoma: A Single-Center Review of 60 Cases from South Africa

  • Surgery in Low and Middle Income Countries
  • Published:
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Abstract

Background

There is a paucity of data on the presentation and surgical management of pheochromocytoma in developing nations, particularly in Africa.

Methods

This study was a retrospective review, which included all patients managed by the Groote Schuur Hospital/University of Cape Town Endocrine Surgery unit for pheochromocytoma and abdominal paragangliomas, from January 2002 to June 2019.

Results

Sixty patients were included in the study, of which 33% were male and 67% female. The mean age was 47 years (range 14–81). The median tumor size was 6 cm, with 45% larger than 6 cm. 92% were located in the adrenal gland (87% unilateral, 5% bilateral), and 8% were extra-adrenal. The conversion rate for laparoscopic cases was 20%, with 55% of cases overall completed laparoscopically. Eleven patients with tumors > 6 cm were initially attempted laparoscopically, of which 3 were converted to open, without any associated increased morbidity. A major adverse event was recorded for 5 cases (8%), including 1 mortality. Overall morbidity, blood loss, operating time and hospital stay were all significantly reduced in the laparoscopic group. There were 5 patients with malignant disease (8%).

Conclusion

This large series, from an established academic endocrine surgery unit in Africa, can serve as a benchmark for units with similar settings and resource limitations, to compare their surgical management and perioperative outcomes.

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References

  1. Conzo G, Pasquali D, Colantuoni V et al (2014) Current concepts of pheochromocytoma. Int J Surg 12:469–474

    Article  Google Scholar 

  2. Hodin R, Lubitz C, Phitayakorn R et al (2014) Diagnosis and management of pheochromocytoma. Curr Probl Surg 51:151–187

    Article  Google Scholar 

  3. Lenders JW, Eisenhofer G, Mannelli M et al (2005) Phaeochromocytoma. Lancet 366:665–675

    Article  Google Scholar 

  4. Lenders JW, Duh QY, Eisenhofer G et al (2014) Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 99:1915–1942

    Article  CAS  Google Scholar 

  5. Plouin PF, Amar L, Dekkers OM et al (2016) European society of endocrinology clinical practice guideline for long-term follow-up of patients operated on for a phaeochromocytoma or a paraganglioma. Eur J Endocrinol 174:G1–G10

    Article  CAS  Google Scholar 

  6. Kazaryan AM, Kuznetsov NS, Shulutko AM et al (2004) Evaluation of endoscopic and traditional open approaches to pheochromocytoma. Surg Endosc 18:937–941

    Article  CAS  Google Scholar 

  7. Thomson BN, Moulton CA, Davies M et al (2004) Laparoscopic adrenalectomy for phaeochromocytoma: with caution. ANZ J Surg 74:429–433

    Article  Google Scholar 

  8. Solorzano CC, Lew JI, Wilhelm SM et al (2007) Outcomes of pheochromocytoma management in the laparoscopic era. Ann Surg Oncol 14:3004–3010

    Article  Google Scholar 

  9. Wilhelm SM, Prinz RA, Barbu AM et al (2006) Analysis of large versus small pheochromocytomas: operative approaches and patient outcomes. Surgery 140:553–560

    Article  CAS  Google Scholar 

  10. Humphrey R, Gray D, Pautler S et al (2008) Laparoscopic compared with open adrenalectomy for resection of pheochromocytoma: a review of 47 cases. Can J Surg 51:276–280

    PubMed  PubMed Central  Google Scholar 

  11. Cotesta D, Petramala L, Serra V et al (2009) Clinical experience with pheochromocytoma in a single centre over 16 years. High Blood Press Cardiovasc Prev 16:183–193

    Article  CAS  Google Scholar 

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

    Article  Google Scholar 

  13. Walz MK, Peitgen K, Neumann HP et al (2002) Endoscopic treatment of solitary, bilateral, multiple, and recurrent pheochromocytomas and paragangliomas. World J Surg 26:1005–1012. https://doi.org/10.1007/s00268-002-6632-x

    Article  PubMed  Google Scholar 

  14. Huddle KR (2011) Phaeochromocytoma in black South Africans–a 30-year audit. S Afr Med J 101:184–188

    Article  CAS  Google Scholar 

  15. Zorgani AE, Pirie FJ, Motala AA (2018) Characteristics and outcome of patients with pheochromocytoma at a tertiary endocrinology clinic in Durban, South Africa over 14 years. J Endocrinol Metab Diabetes S Afr 23:52–58

    Google Scholar 

  16. Johnson O (2004) Phaeochromocytoma: experience with 12 cases in Tikur Anbessa, Addis Ababa, Ethiopia. East Cent Afr J Surg 9:71–75

    Google Scholar 

  17. Leye A, Ndiaye N, Leye YM et al (2018) Management of Pheochromocytoma in Dakar: diagnostic and Therapeutic Advances throughout 16 Cases. Open J Endocr Metab Dis 8:19–28

    Article  Google Scholar 

  18. Agarwal G, Sadacharan D, Aggarwal V et al (2012) Surgical management of organ-contained unilateral pheochromocytoma: comparative outcomes of laparoscopic and conventional open surgical procedures in a large single-institution series. Langenbeck’s Arch Surg 397:1109–1116

    Article  Google Scholar 

  19. Kopetschke R, Slisko M, Kilisli A et al (2009) Frequent incidental discovery of phaeochromocytoma: data from a German cohort of 201 phaeochromocytoma. Eur J Endocrinol 161:355–361

    Article  CAS  Google Scholar 

  20. Baguet JP, Hammer L, Mazzuco TL et al (2004) Circumstances of discovery of phaeochromocytoma: a retrospective study of 41 consecutive patients. Eur J Endocrinol 150:681–686

    Article  CAS  Google Scholar 

  21. Shen WT, Grogan R, Vriens M et al (2010) One hundred two patients with pheochromocytoma treated at a single institution since the introduction of laparoscopic adrenalectomy. Arch Surg 145:893–897

    Article  Google Scholar 

  22. Agarwal A, Mehrotra PK, Jain M et al (2010) Size of the tumor and pheochromocytoma of the adrenal gland scaled score (PASS): can they predict malignancy? World J Surg 34:3022–3028. https://doi.org/10.1007/s00268-010-0744-5

    Article  PubMed  Google Scholar 

  23. Lorenz K, Langer P, Niederle B et al (2019) Surgical therapy of adrenal tumors: guidelines from the German Association of Endocrine Surgeons. Langenbeck’s Arch Surg 404:385–401

    Article  CAS  Google Scholar 

  24. Li ML, Fitzgerald PA, Price DC et al (2001) Iatrogenic pheochromocytomatosis: a previously unreported result of laparoscopic adrenalectomy. Surgery 130:1072–1077

    Article  CAS  Google Scholar 

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Correspondence to D. Nel.

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Nel, D., Panieri, E., Malherbe, F. et al. Surgery for Pheochromocytoma: A Single-Center Review of 60 Cases from South Africa. World J Surg 44, 1918–1924 (2020). https://doi.org/10.1007/s00268-020-05420-6

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