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Minimally invasive cortical-sparing surgery for bilateral pheochromocytomas

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Abstract

Introduction

Cortical-sparing adrenalectomy in bilateral pheochromocytomas offers a postoperative corticoid-free course and has to be balanced against the risk of local recurrence. In this study we report our experience with the minimally invasive cortical-sparing adrenalectomy in patients with bilateral pheochromocytomas.

Methods

From January 1996 to February 2011, 66 patients (45 men, 21 women; mean age 36 ± 16 years) were treated for bilateral pheochromocytomas. Fifty-seven patients (88%) were affected by genetic diseases. In 32 patients surgery was synchronously performed on both side, in 34 cases adrenalectomy followed previous surgery. All in all, 101 operations (47 right, 54 left) were conducted using the retroperitoneoscopic access (n = 97) or the laparoscopic route (n = 4).

Results

The mortality in our series was zero. Postoperative complications included one patient with a bleeding requiring reoperation and one patient developing a cerebral stroke on the fifth postoperative day. The mean operative time was 67 ± 26 min for unilateral adrenalectomy and 128 ± 68 min for bilateral surgery (range 25–300 min). A cortical-sparing resection was possible in 89 procedures resulting in a corticoid-free postoperative course in 60 patients (91%). A postoperative corticosteroid substitution therapy was necessary in six patients. During a median follow-up period of 48 months, one patient showed a persistent disease and needed reoperation, none developed a recurrent disease.

Conclusion

Cortical-sparing surgery for bilateral pheochromocytomas has a low recurrence rate and avoids lifelong cortisone substitution therapy in the majority of cases.

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References

  1. Manger WM (2006) An overview of pheochromocytoma: history, current concepts, vagaries, and diagnostic challenges. Ann N Y Acad Sci 1073:1–20

    Article  PubMed  CAS  Google Scholar 

  2. Neumann HP, Vortmeyer A, Schmidt D, Werner M, Erlic Z, Cascon A, Bausch B, Januszewicz A, Eng C (2007) Evidence of MEN-2 in the original description of classic pheochromocytoma. N Engl J Med 357:1311–1315

    Article  PubMed  CAS  Google Scholar 

  3. Neumann HP, Bausch B, Mcwhinney SR, Bender BU, Gimm O, Franke G, Schipper J, Klisch J, Altehoefer C, Zerres K, Januszewicz A, Eng C, Smith WM, Munk R, Manz T, Glaesker S, Apel TW, Treier M, Reineke M, Walz MK, Hoang-Vu C, Brauckhoff M, Klein-Franke A, Klose P, Schmidt H, Maier-Woelfle M, Peczkowska M, Szmigielski C (2002) Germ-line mutations in nonsyndromic pheochromocytoma. N Engl J Med 346:1459–1466

    Article  PubMed  CAS  Google Scholar 

  4. Petri BJ, Van Eijck CH, De Herder WW, Wagner A, De Krijger RR (2009) Phaeochromocytomas and sympathetic paragangliomas. Br J Surg 96:1381–1392

    Article  PubMed  Google Scholar 

  5. Gates FL (1918) Antibody production after partial adrenalectomy in guinea pigs. J Exp Med 27:725–738

    Article  PubMed  CAS  Google Scholar 

  6. Decourcy JL (1934) Subtotal bilateral adrenalectomy for hyperadrenalism (essential hypertension). Ann Surg 100:310–318

    Article  PubMed  CAS  Google Scholar 

  7. Broster LR (1948) Adrenal virilism (group I) bilateral partial adrenalectomy. Proc R Soc Med 41:196

    PubMed  CAS  Google Scholar 

  8. Giordano WC (1982) Preservation of adrenocortical function during surgery for bilateral pheochromocytoma. J Urol 127:100–102

    PubMed  CAS  Google Scholar 

  9. Irvin GL 3rd, Fishman LM, Sher JA (1983) Familial pheochromocytoma. Surgery 94:938–940

    PubMed  Google Scholar 

  10. Lairmore TC, Ball DW, Baylin SB, Wells S Jr (1993) Management of pheochromocytomas in patients with multiple endocrine neoplasia type 2 syndromes. Ann Surg 217:595–601

    Article  PubMed  CAS  Google Scholar 

  11. Asari R, Scheuba C, Kaczirek K, Niederle B (2006) Estimated risk of pheochromocytoma recurrence after adrenal-sparing surgery in patients with multiple endocrine neoplasia type 2A. Arch Surg 141:1199–1205, discussion 1205

    Article  PubMed  CAS  Google Scholar 

  12. Walz MK (2004) Extent of adrenalectomy for adrenal neoplasm: cortical sparing (subtotal) versus total adrenalectomy. Surg Clin North Am 84:743–753

    Article  PubMed  Google Scholar 

  13. Walz MK, Peitgen K, Hoermann R, Giebler RM, Mann K, Eigler FW (1996) Posterior retroperitoneoscopy as a new minimally invasive approach for adrenalectomy: results of 30 adrenalectomies in 27 patients. World J Surg 20:769–774

    Article  PubMed  CAS  Google Scholar 

  14. Walz MK, Peitgen K, Saller B, Giebler RM, Lederbogen S, Nimtz K, Mann K, Eigler FW (1998) Subtotal adrenalectomy by the posterior retroperitoneoscopic approach. World J Surg 22:621–626, discussion 626–627

    Article  PubMed  CAS  Google Scholar 

  15. Walz MK, Alesina PF, Wenger FA, Koch JA, Neumann HP, Petersenn S, Schmid KW, Mann K (2006) Laparoscopic and retroperitoneoscopic treatment of pheochromocytomas and retroperitoneal paragangliomas: results of 161 tumors in 126 patients. World J Surg 30:899–908

    Article  PubMed  Google Scholar 

  16. Walz MK, Gwosdz R, Levin SL, Alesina PF, Suttorp AC, Metz KA, Wenger FA, Petersenn S, Mann K, Schmid KW (2008) Retroperitoneoscopic adrenalectomy in Conn's syndrome caused by adrenal adenomas or nodular hyperplasia. World J Surg 32:847–853

    Article  PubMed  Google Scholar 

  17. Alesina PF, Hommeltenberg S, Meier B, Petersenn S, Lahner H, Schmid KW, Mann K, Walz MK (2010) Posterior retroperitoneoscopic adrenalectomy for clinical and subclinical Cushing's syndrome. World J Surg 34:1391–1397

    Article  PubMed  Google Scholar 

  18. Walz MK, Alesina PF, Wenger FA, Deligiannis A, Szuczik E, Petersenn S, Ommer A, Groeben H, Peitgen K, Janssen OE, Philipp T, Neumann HP, Schmid KW, Mann K (2006) Posterior retroperitoneoscopic adrenalectomy—results of 560 procedures in 520 patients. Surgery 140:943–948, discussion 948–950

    Article  PubMed  Google Scholar 

  19. Walz MK, Alesina PF (2009) Single access retroperitoneoscopic adrenalectomy (SARA)—one step beyond in endocrine surgery. Langenbecks Arch Surg 394:447–450

    Article  PubMed  Google Scholar 

  20. Brauckhoff M, Thanh PN, Gimm O, Bar A, Brauckhoff K, Dralle H (2003) Functional results after endoscopic subtotal cortical-sparing adrenalectomy. Surg Today 33:342–348

    Article  PubMed  Google Scholar 

  21. Parnaby CN, Galbraith N, O'dwyer PJ (2010) Importance of the adrenal gland blood supply during laparoscopic subtotal adrenalectomy. J Laparoendosc Adv Surg Tech A 20:311–315

    Article  PubMed  Google Scholar 

  22. Walz MK, Peitgen K, Diesing D, Petersenn S, Janssen OE, Philipp T, Metz KA, Mann K, Schmid KW, Neumann HP (2004) Partial versus total adrenalectomy by the posterior retroperitoneoscopic approach: early and long-term results of 325 consecutive procedures in primary adrenal neoplasias. World J Surg 28:1323–1329

    Article  PubMed  Google Scholar 

  23. Neumann HP, Bender BU, Reincke M, Eggstein S, Laubenberger J, Kirste G (1999) Adrenal-sparing surgery for phaeochromocytoma. Br J Surg 86:94–97

    Article  PubMed  CAS  Google Scholar 

  24. Lee JE, Curley SA, Gagel RF, Evans DB, Hickey RC (1996) Cortical-sparing adrenalectomy for patients with bilateral pheochromocytoma. Surgery 120:1064–1070

    Article  PubMed  CAS  Google Scholar 

  25. Kiriakopoulos A, Economopoulos KP, Poulios E, Linos D (2011) Impact of posterior retroperitoneoscopic adrenalectomy in a tertiary care center: a paradigm shift. Surg Endosc. doi:10.1007/s00464-011-1762-6

  26. Walz MK, Groeben H, Alesina PF (2010) Single-access retroperitoneoscopic adrenalectomy (SARA) versus conventional retroperitoneoscopic adrenalectomy (CORA): a case–control study. World J Surg 34:1386–1390

    Article  PubMed  Google Scholar 

  27. Lombardi CP, Raffaelli M, De Crea C, Bellantone R, Fusco A, Bianchi A, Pontecorvi A, De Marinis L (2011) ACTH-dependent Cushing syndrome: the potential benefits of simultaneous bilateral posterior retroperitoneoscopic adrenalectomy. Surgery 149:299–300

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  29. Van Heerden JA, Sizemore GW, Carney JA, Grant CS, Remine WH, Sheps SG (1984) Surgical management of the adrenal glands in the multiple endocrine neoplasia type II syndrome. World J Surg 8:612–621

    Article  PubMed  Google Scholar 

  30. Albanese CT, Wiener ES (1993) Routine total bilateral adrenalectomy is not warranted in childhood familial pheochromocytoma. J Pediatr Surg 28:1248–1251

    Article  PubMed  CAS  Google Scholar 

  31. Walz MK (2009) Adrenalectomy for preservation of adrenocortical function. Indication and results. Chirurg 80:99–104

    Article  PubMed  CAS  Google Scholar 

  32. Jansson S, Khorram-Manesh A, Nilsson O, Kolby L, Tisell LE, Wangberg B, Ahlman H (2006) Treatment of bilateral pheochromocytoma and adrenal medullary hyperplasia. Ann N Y Acad Sci 1073:429–435

    Article  PubMed  Google Scholar 

  33. Brauckhoff M, Gimm O, Brauckhoff K, Dralle H (2004) Repeat adrenocortical-sparing adrenalectomy for recurrent hereditary pheochromocytoma. Surg Today 34:251–255

    Article  PubMed  Google Scholar 

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Conflicts of interest

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Authors and Affiliations

  1. Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Henricistrasse 92, 45136, Essen, Germany

    Pier Francesco Alesina, Jakob Hinrichs, Beate Meier & Martin K. Walz

  2. Institut für Pathologie und Neuropathologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany

    Kurt W. Schmid

  3. Medizinische Klinik und Poliklinik, Abteilung für Innere Medizin IV, Universitätsklinikum Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany

    Hartmut P. H. Neumann

Authors
  1. Pier Francesco Alesina
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  2. Jakob Hinrichs
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  3. Beate Meier
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  4. Kurt W. Schmid
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  5. Hartmut P. H. Neumann
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  6. Martin K. Walz
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Corresponding author

Correspondence to Pier Francesco Alesina.

Additional information

This paper was presented at the ESES Workshop in Lyon, France, Mai 2011.

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Alesina, P.F., Hinrichs, J., Meier, B. et al. Minimally invasive cortical-sparing surgery for bilateral pheochromocytomas. Langenbecks Arch Surg 397, 233–238 (2012). https://doi.org/10.1007/s00423-011-0851-2

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  • DOI: https://doi.org/10.1007/s00423-011-0851-2

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