Is the laparoscopic adrenalectomy for pheochromocytoma the best treatment?

• Published in: Surgery 2007-06, Vol.141 (6), p.723-727
• Main Authors: Toniato, Antonio, MD, Boschin, Isabella Merante, MD, Opocher, Giuseppe, MD, Guolo, Annamaria, Pelizzo, Mariarosa, MD, Mantero, Franco, MD
• Format: Article
• Language: English
• Subjects: Adrenal Gland Neoplasms - surgery; Adrenalectomy - methods; Adrenals. Adrenal axis. Renin-angiotensin system (diseases); Adult; Aged; Analgesia; Biological and medical sciences; Blood Loss, Surgical; Critical Care; Endocrinopathies; Feasibility Studies; Female; Follow-Up Studies; General aspects; Humans; Hypertension - etiology; Intraoperative Complications; Laparoscopy; Length of Stay; Male; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Pheochromocytoma - surgery; Postoperative Care; Surgery; Time Factors
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2006.10.012

Background Laparoscopic adrenalectomy has become the gold standard for removing adrenal masses, but several authors still debate the role of laparoscopic adrenalectomy in pheochromocytoma. The purpose of this study was to evaluate the short- and long-term outcomes of laparoscopic versus open adrenalectomy for pheochromocytomas and to compare the feasibility and safety of laparoscopic adrenalectomy for neoplasms that are smaller than 6 cm versus those that are larger than 6 cm. Methods From January 1990 to December 2005, the same team in our department carried out 221 adrenalectomies in 211 patients. A total of 64 of these patients underwent 71 adrenalectomies for pheochromocytoma, 24 patients (37%) had open adrenalectomy, and 40 patients (63%) had laparoscopic adrenalectomy. Sex, age, side and size of lesion, operating time, duration of hospital stay, need for intensive care, intraoperative blood pressure variations, blood loss, postoperative analgesia, return to oral nutrition, and complications were compared among groups. Results An advantage of laparoscopic adrenalectomy over open adrenalectomy was observed in mean operating time, hospital stay, need for intensive care, intraoperative hypertension, intraoperative blood loss, postoperative analgesia, and return to oral nutrition ( P ≤ .035 in all). The analysis of tumor size (≤6 vs >6 cm) in laparoscopic adrenalectomy showed that none of the variables differed significantly, except for intraoperative blood loss, which was greater for the larger neoplasms ( P = .007). Conclusions Laparoscopic adrenalectomy, when performed by experienced laparoscopic surgeons, is preferable to open adrenalectomy for the majority of pheochromocytomas, and as long as there is no evidence of invasion of surrounding structures, tumor size does not appear to have a profound effect on surgical outcome.