Evolution of surgical management for phaeochromocytoma over a 17‐year period: an Australian perspective

Abstract

Background: Minimally invasive adrenalectomy and advances in anaesthetic techniques have transformed surgery for phaeochromocytoma. This 17-year review describes the evolution of phaeochromocytoma care in our unit. Methods: We performed a retrospective cohort review of all patients who underwent adrenalectomy for phaeochromocytoma from 2000 to 2016. Patients were divided into three time periods, early: 2000-2005 (n = 17), middle: 2006-2010 (n = 15) and late: 2011-2016 (n = 24). The posterior retroperitoneoscopic adrenalectomy was introduced in 2011. Demographics and clinicopathological details were extracted. Median values for nominal data were compared using Mann-Whitney U-test. A chi-squared test was used to compare categorical data.Results: Sixty-one adrenalectomies were performed on 56 patients: 19 open, 17 laparoscopic and 20 posterior retroperitoneoscopic adrenalectomies. The median length of operation decreased from 135 to 90 min from the early to the late time period (P > 0.05). Length of stay decreased from a median of 5 days in the early group to 1 day in the late group (P = 0.01). A total of 94.1% of the early period patients were admitted to the intensive care unit compared to 30.4% of the late group (P = <0.01). Need for post-operative vasopressors and blood transfusions was significantly reduced. Conclusion: Over the 17-year period, the choice of operative technique has transitioned towards posterior retroperitoneoscopic adrenalectomy. Operative time, rate of intensive care unit admission, and admission length have all decreased without any increase in rates of complications.

Surgical outcomes in the pheochromocytoma surgery. Results from the PHEO-RISK STUDY

“…However, the rate of complications is widely variable among series, ranging from 10-40% [8][18] [11] [19]. There are several plausible explanations for this wide range, including referral biases, differences in the de nition of complications and in the type of complications reported, and importantly, the decade of the performed research as it is known that a signi cant reduction in pheochromocytoma surgical treatment morbidity and mortality has taken place over recent decades [20]. In agreement with our study, series evaluating the severity of complications found similar gures of grade III and IV complications in the Clavien-Dindo score [10][9] [11], although in some series severe complications occurred in up to 31% of the cases [8].…”

Minimally invasive adrenalectomy: a cohort study of surgical approach and outcomes

“…This incidence was similar to other studies (2.0%-8.5%) 7,8,13,15,23 and presented transiently as abdominal wall laxity, pain or sensory changes. 7,15,23 By avoiding breaching the peritoneum, PRA may offer reduced post-operative pain, 11,15 and account for no post-operative ileus being observed. Haemorrhage or haematoma occurred more commonly after TPA (1.8%) than PRA (0.4%), and triggered conversion in two cases.…”

“…High insufflation pressure (20 mmHg) in the retroperitoneal space may contribute to a lower risk of PRA conversion due to bleeding. 11,13,14 However, venous compression may contribute to VTE formation after PRA (1.3%). This contradicts studies reporting 0% incidence following PRA 13,15,20 and occurring after TPA only (0.4%-1.5%).…”

“…6,10,13,18 Key advantages of this study were its 17-year duration, large cohort size, and location in a high-volume centre, therefore providing an additional Australian perspective to existing small-sized studies on phaeochromocytomas. 11,14,22,23 Despite phaeochromocytoma being a rare malignancy, it represented the second most frequent indication with a rising number in Cohort 2, which could reflect an increase in pathology or referral bias. The most common referral was a benign, non-functional incidentaloma detected on imaging.…”

“…4,5 PRA may offer reduced blood loss, post-operative pain, and hospital stay, and earlier ambulation compared to TPA. 2,4,5,[7][8][9][10][11] The choice between TPA and PRA depends on surgeon preference, patient characteristics (obesity, anatomical constraints, surgical history), and tumour factors (size, risk of malignancy). 12,13 Aside from the advantages of PRA in patients with previous abdominal surgery or bilateral adrenal disease, 2,4,10,12 there is no consensus on whether TPA or PRA is the superior minimally invasive approach.…”