Abstract
Re-operative adrenal surgery for recurrent pheochromocytoma/paraganglioma (PCC/PGL) is a therapeutic situation not commonly encountered. The recurrence rate of pheochromocytoma is estimated to be 6.1–16.5% of patients from published retrospective series; there are no reports from the Asian continent. A retrospective analysis of the departmental database was performed on patients who had undergone surgery for PCC/PGL from January 2004 to December 2014 at the Christian Medical College Hospital, Vellore, India. Among 99 patients identified during the study period, there were 14 recurrent tumours and 13 patients underwent re-operative surgery. We located eight recurrences on the right side, three on the left side and three in the midline. All 14 recurrences were functioning, and the biochemical analysis as well as imaging studies were positive in 13 of them. The mean duration to recurrence from the time of the primary surgery was 76.3 months (range 6–180 months). Of the 89 patients who underwent their first operation at our centre, 67.4% reported for follow-up for a mean period of 25 months (range 4–132 months). Four of these required re-operation with a recurrence rate of 4.5% (4/89). The open approach was used for all but one of the recurrent tumours. Recurrence following surgery for PCC/PGL is a rarely studied though significant problem. Right adrenal tumour recurrences were most common, and all these recurrences were in the retrocaval region; this typical phenomenon may be dubbed the ‘right retrocaval trap’. The reason for this was presumably due to difficult access and inadequate exposure of this area in open and laparoscopic surgery, resulting in incomplete dissection.
Similar content being viewed by others
References
Amar L, Servais A, Gimenez-Roqueplo AP, Zinzindohoue F, Chatellier G, Plouin PF (2005. Apr) Year of diagnosis, features at presentation, and risk of recurrence in patients with pheochromocytoma or secreting paraganglioma. J Clin Endocrinol Metab 90(4):2110–2116
Plouin PF, Chatellier G, Fofol I, Corvol P (1997) Tumour recurrence and hypertension persisting after successful pheochromocytoma operation. Hypertension 29(5):1133–1139
vanHeerden JA, Roland CF, Carney JA, Sheps SG, Grant CS (1990) Long term evaluation following resection of apparently benign pheochromocytoma(s)/paraganglioma(s). World J Surg 14(3):325–329
Shen WT, Grogan R, Vriens M, Clark OH, Duh QY (2010) One hundred two patients with pheochromocytoma treated at a single institution since the introduction of laparoscopic adrenalectomy. Arch Surg 145(9):893–897
Press D, Akyuz M, Dural C et al (2014) Predictors of recurrence in pheochromocytoma. Surgery 156(6):1523–1527
Pruszczyk P, Januszewicz W, Feltynowski T, Chodakowska J, Wocial B, Pachocki R, Nielubowicz J, Szostek M (1991) Long term follow-up after surgical removal of pheochromocytoma—observations in 61 patients. Clin Exp Hypertens A 13(6–7):1179–1194
Pai R, Ebenazer A, Paul MJ, Thomas N, Nair A, Seshadri MS, Oommen R, Shanthly N, Devasia A, Rebekah G, Jeyaseelan L, Rajaratnam S (2015) Mutations seen among patients with pheochromocytoma and paraganglioma at a referral center from India. Horm Metab Res 47:133–137
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Sonbare, D.J., Abraham, D.T., Rajaratnam, S. et al. Re-operative Surgery for Pheochromocytoma-Paraganglioma: Analysis of 13 Cases from a Single Institution. Indian J Surg 80, 123–127 (2018). https://doi.org/10.1007/s12262-017-1658-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12262-017-1658-3