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Endoscopic treatment of recurrent phaeochromocytomas and retroperitoneal paragangliomas

Die endoskopische Therapie rezidivierter Phäochromozytome und retroperitonealer Paragangliome

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Summary

Background: Endoscopic removal of recurrent phaeochromocytomas and retroperitoneal paragangliomas (extra-adrenal phaeochromocytomas) is a challenging surgical procedure.

Methods: In a prospective clinical study, five patients (three males, two females; age: 15–63 years) with recurrent phaeochromocytomas and eight patients (three males, five females; age: 21–60 years) with paragangliomas (twice in combination with phaeochromocytomas) were treated endoscopically. Three patients showed multiple (2 to 5) tumours. Tumour size ranged from 1 to 4 cm. Six patients suffered from von Hippel-Lindau disease. Twelve tumours were removed using the laparoscopic route; the retroperitoneoscopic technique was performed for nine tumours. High-dosage alpha-blockage with phenoxybenzamine was routinely used.

Results: Conversion to open surgery was not necessary. Minor perioperative complications occurred in two patients (15 %); mortality was zero. Mean operating time for recurrent phaeochromocytomas was 172 min (range: 120–255 min), and operating time for paragangliomas ranged from 75 to 600 min. Mean blood loss was 130 mL, and median duration of postoperative hospitalization was 5 days. No recurrences were observed at a mean follow-up of 30 months.

Conclusions: Endoscopic removal of recurrent phaeochromocytomas and retroperitoneal paragangliomas is feasible and safe but requires extensive experience in minimally invasive surgery as well as in endocrine surgery.

Zusammenfassung

Grundlagen: Die endoskopische Exstirpation von Phäochromozytom-Rezidiven und von retroperitonealen Paragangliomen (extraadrenalen Phäochromozytomen) ist eine besondere chirurgische Herausforderung.

Methodik: Im Rahmen einer prospektiven Studie wurden 5 Patienten (3 m, 5 w, Alter 15–63 Jahren) mit rezidivierten Phäochromozytomen und 8 Patienten (3 m, 5 w, Alter 21–60 Jahre) mit extraadrenalen Phäochromozytomen (zweimal in Kombination mit adrenalen Phäochromozytomen) endoskopisch opeiert. Drei Patienten hatten multiple (2 bis 5) Tumoren. Die Tumorgröße schwankte zwischen 1 und 4 cm. Sechs Patienten litten an von Hippel-Lindau-Syndrom. Die laparoskopische Methode wurde bei 12 Tumoren angewandt, 9 Neoplasien wurden retroperitoneoskopisch entfernt. Eine hochdosierte α-Rezeptorblokkade mit Phenoxybenzamin wurde routinemäßig angewandt.

Ergebnisse: Eine Konversion zur offenen Technik war in keinem Falle erforderlich. Perioperativ traten bei 2 Patienten (15%) unbedeutende Komplikationen auf, kein Patient ist verstorben. Die mittlere Operationsdauer lag bei den Phäochromozytom-Rezidiven bei 172 Minuten (Spanne: 120–255 Minuten), bei den extraadrenalen Phäochromozytomen schwankte sie zwischen 75 und 600 Minuten. Der Blutverlust lag bei 130 mL, der mediane postoperative Klinikaufenthalt bei 5 Tagen. Rezidive wurden nach einer medianen Nachbeobachtungszeit von 30 Monaten nicht beobachtet.

Schlußfolgerungen: Die endoskopische Therapie von Phäochromozytom-Rezidiven und von retroperitonealen Paragangliomen ist unter extensive Erfahrung in der minimal-invasiven Methodik und der endokrinen Chirurgie sicher durchführbar.

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Authors and Affiliations

  1. From the Department of Surgery and Centre of Minimally Invasive Surgery, Kliniken Essen-Mitte, Akademisches Lehrkrankenhaus, University of Essen, Germany

    M. K. Walz M.D. & K. Peitgen

  2. the Department of Internal Medicine IV, Medizinische Klinik und Poliklinik, University Hospital of Freiburg, Germany

    H. P. H. Neumann

  3. Department of Endocrinology, Centre of Internal Medicine, University Hospital of Essen, Germany

    St. Petersenn, O. E. Janssen & K. Mann

Authors
  1. M. K. Walz M.D.
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  2. H. P. H. Neumann
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  3. K. Peitgen
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  4. St. Petersenn
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  5. O. E. Janssen
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  6. K. Mann
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Correspondence to M. K. Walz M.D..

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Walz, M.K., Neumann, H.P.H., Peitgen, K. et al. Endoscopic treatment of recurrent phaeochromocytomas and retroperitoneal paragangliomas. Eur Surg 35, 93–96 (2003). https://doi.org/10.1046/j.1682-4016.2003.03051.x

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  • DOI: https://doi.org/10.1046/j.1682-4016.2003.03051.x

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