Laparoscopic versus robotic adrenalectomy in pheochromocytoma patients

Abstract

Background and Objectives Pheochromocytoma is a challenging tumor type requiring resection with a clear margin and an intact capsule to prevent recurrences. Our aim was to compare perioperative outcomes of laparoscopic adrenalectomy (LA) versus robotic adrenalectomy (RA) for pheochromocytoma. Methods In an institutional review board‐approved retrospective study, clinical parameters of patients who underwent LA versus RA at a single center were compared using Mann–Whitney U, χ2, and survival analyses. Continuous data are expressed as median (interquartile range). Results There was a total of 157 patients (RA: n = 87, LA: n = 70) analyzed. Estimated blood loss (36.3 [35.0] vs. 99.9 [65.0] cc, p = 0.020) and hospital stay (1.3 [0.0] vs. 2.2 [1.0] days, p = 0.010) were lower in robotic versus laparoscopic group, respectively. Disease‐free and overall survival was similar between groups. The rate of conversion to open for tumors ≥5 cm was less in the robotic group (0% vs. 14%, respectively, p = 0.048). Conclusion In this study, long‐term outcomes of LA and RA were similar, although adrenalectomies performed robotically were associated with less blood loss, shorter hospital stay, and a lower chance of conversion to open in the case of large tumors.

Comparison of the retroperitoneal laparoscopic adrenalectomy versus transperitoneal laparoscopic adrenalectomy for large (≥6cm) pheochromocytomas: A single-centre retrospective study

“…Robotic surgical systems overcome the limitations of laparoscopic surgery, such as twodimensional imaging and surgeon discomfort. Robot-assisted laparoscopic adrenalectomy involves less EBL and faster postoperative recovery than laparoscopic adrenalectomy (16,17). For large adrenal pheochromocytomas, many scholars believe that open surgery should be used, because they believe that these tumors tend to be malignant and that open surgery can facilitate a more complete resection of the tumor.…”

Laparoscopic adrenalectomy for adrenal tumors with endocrine activity: Perioperative management pathways for reduced complications and improved outcomes

“…71 LA is the standard treatment for PPGLs due to improvements of perioperative medical management and careful minimally invasive surgery. 72,73 Although surgical resection of PPGLs is the only curative treatment, a massive release of catecholamines during the induction of anesthesia or surgical manipulation of tumor can make it more difficult and complicated. 74 Perioperative HDI sometimes occurs due to broad fluctuations in serum catecholamine levels.…”

“…83,84 Although progressive multiorgan failure may leave emergency tumor resection as the sole option in PPGL patients with shock due to hemorrhagic necrosis or rupture of a tumor, many studies have suggested that PMC patients undergoing intensive medical stabilization before surgical resection have good outcomes. [73][74][75][76][77][78][79][80][81][82][83][84][85] From a retrospective study and literature review, Scholten et al showed that preoperative management of PMC should include initial stabilization by sufficient alpha blockade, and emergency surgery is significantly related to high morbidity and mortality. 83…”

“…PMC can occur spontaneously or can be precipitated by manipulation of the tumor, trauma, certain medications (corticosteroids, beta blockers, metoclopramide, and anesthetic agents), or stress from non‐adrenal surgery 83,84 . Although progressive multiorgan failure may leave emergency tumor resection as the sole option in PPGL patients with shock due to hemorrhagic necrosis or rupture of a tumor, many studies have suggested that PMC patients undergoing intensive medical stabilization before surgical resection have good outcomes 73–85 . From a retrospective study and literature review, Scholten et al.…”

“…The symptoms can range from clinically asymptomatic to life‐threatening hypertensive crisis, ventricular arrhythmia, myocardial infarction, stroke, and death in PPGL patients 71 . LA is the standard treatment for PPGLs due to improvements of perioperative medical management and careful minimally invasive surgery 72,73 . Although surgical resection of PPGLs is the only curative treatment, a massive release of catecholamines during the induction of anesthesia or surgical manipulation of tumor can make it more difficult and complicated 74 .…”