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Laparoscopic and Retroperitoneoscopic Treatment of Pheochromocytomas and Retroperitoneal Paragangliomas: Results of 161 Tumors in 126 Patients

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Abstract

Background

Laparoscopic and retroperitoneoscopic excisions of pheochromocytomas and retroperitoneal paragangliomas are challenging surgical procedures because of extensive intraoperative catecholamine release, extreme vascularization, and demanding localization.

Materials

In a prospective clinical study 161 chromaffine neoplasias (134 pheochromocytomas, 27 paragangliomas) were removed endoscopically in 126 patients (67 males, 59 females, age 41.7 ± 16.4 years; 130 operations). Six patients showed multiple (2–5) tumors. Tumor size ranged from 0.5 to 12 cm (mean 3.5 ± 1.9 cm). Forty-two patients suffered from hereditary diseases. Twenty-four patients had bilateral adrenal diseases; in 14 patients pheochromocytomas were removed on both sides synchroneously. Ten neoplasias were local or loco-regional recurrences (7 pheochromocytomas, 3 paragangliomas). The laparoscopic route was chosen in 16 operations; the retroperitoneoscopic technique was performed in 128 others. Partial adrenalectomies were performed in 57 operations (in all but one of the patients with bilateral disease). High-dosage α-blockade with phenoxybenzamine was routinely used.

Results and Discussion

Conversion to open surgery occurred once. Perioperative complications were minor (17%); mortality was zero. Operating time for unilateral retroperitoneoscopically removed primary pheochromocytomas (n = 113) was 82 ± 49 minutes (range: 20–300 minutes) and depended on tumor size (< 3 cm vs. ≥ 3 cm; P < 0.05) and gender (P < 0.001), but not on extent of resection (partial vs. total, P = 0.266). Operating time for paragangliomas ranged from 55 to 600 minutes. Median blood loss was 20 ml. Median duration of postoperative hospitalization was 4 days. In 22 of 24 patients with bilateral disease, complete preservation of cortical function was achieved. Locoregional and/or distant metastatic recurrence were found in 5 patients.

Conclusions

Endoscopic removal of solitary, bilateral, multiple, and recurrent pheochromocytomas and retroperitoneal paragangliomas is feasible and safe, but surgeons need extensive experience in minimally invasive techniques, as well as in endocrine surgery.

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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, Essen, D-45136, Germany

    Martin K. Walz MD, Piero F. Alesina MD & Frank A. Wenger MD

  2. Klinik für Diagnostische und Interventionelle Radiologie, Kliniken Essen-Mitte, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Henricistrasse 92, Essen, D-45136, Germany

    J. Albrecht Koch MD

  3. Medizinische Klinik und Poliklinik, Abteilung für Innere Medizin IV, Universitätsklinikum Freiburg, Hugstetter Strasse 55, Freiburg, D-79106, Germany

    Hartmut P. H. Neumann MD

  4. Abteilung für Endokrinologie, Universitätsklinikum Essen, Hufelandstrasse 55, Essen, D-45122, Germany

    Stephan Petersenn MD & Klaus Mann MD

  5. Institut für Pathologie, Universitätsklinikum Essen, Hufelandstrasse 55, Essen, D-45122, Germany

    Kurt W. Schmid MD

Authors
  1. Martin K. Walz MD
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  2. Piero F. Alesina MD
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  3. Frank A. Wenger MD
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  4. J. Albrecht Koch MD
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  5. Hartmut P. H. Neumann MD
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  6. Stephan Petersenn MD
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Correspondence to Martin K. Walz MD.

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Walz, M.K., Alesina, P.F., Wenger, F.A. et al. Laparoscopic and Retroperitoneoscopic Treatment of Pheochromocytomas and Retroperitoneal Paragangliomas: Results of 161 Tumors in 126 Patients. World J. Surg. 30, 899–908 (2006). https://doi.org/10.1007/s00268-005-0373-6

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  • DOI: https://doi.org/10.1007/s00268-005-0373-6

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