Prospective randomized comparison of laparoscopic versus open adrenalectomy for sporadic pheochromocytoma

Abstract

Background Laparoscopic adrenalectomy for pheochromocytoma remains subject of debate, owing to the systemic consequences of pneumoperitoneum in patients with catecholamine-secreting tumors. Methods A prospective randomized study was conducted (2000)(2001)(2002)(2003)(2004)(2005)(2006), evaluating cardiovascular instability during open (n = 9, group A) or laparoscopic (n = 13, group B) adrenalectomy for pheochromocytoma. Haemodynamic parameters were recorded by invasive monitoring. Results Haemodynamic instability was observed in 3/9 (group A) and 6/13 patients (group B), with a mean of 1.8 and 2.2 hypertensive peaks per patient (p = n.s.). Blood loss (164 ± 94 cc versus 48 ± 36 cc, p \ 0.05) and operative time (180 ± 40 versus 158 ± 45 min, p = n.s.) favored laparoscopic procedures. Postoperative morbidity and mortality were nil. Hospital stay was shorter in group B (p \ 0.05). Long-term follow-up was always normal.Conclusions Laparoscopic approach for pheochromocytoma can be as safe as open surgery; intraoperative haemodynamic instability, although usually controlled with success, remains a source of concern.

A case of clinically silent giant right pheochromocytoma and review of literature

“…4 Once the adrenal neoplasm is diagnosed, resection is the only curative treatment. Although some reports have concluded that laparoscopic adrenalectomy is safe, effective, and minimally invasive, [5][6][7] it is considered a gold standard in Post-contrast computed tomography axial plane shows the mass pressurizing liver forward and laterally. Outside area of the mass displays significant enhancement with uneven thickness.…”

A Comparison of Two Approaches to Laparoscopic Adrenalectomy: Lateral Transperitoneal Versus Posterior Retroperitoneal Approach

“…haemodynamic disorders due to excessive manipulations [5]. Currently, the minimally invasive adrenalectomy is successfully used in more than 90% of phaeochromocytoma cases, preceded by preoperative pharmacotherapy to inhibit the hormonal activity of the tumor [6][7][8][9].…”

“…Tumors of more than 12 cm in diameter and malignant lesions infiltrating other tissues should be operated using conventional approaches [3,7]. In the case of malignant non-infiltrating tumors of 4 to 6 cm, both open and minimally invasive approaches to adrenalectomy are acceptable [11].…”

Surgical Management of Pheochromocytoma in a Contemporary Setting

“…Recent studies had confirmed that laparoscopic adrenalectomy is a safe and effective treatment for pheochromocytoma [23][24][25][26][27][28]. Patients who had laparoscopic adrenalectomy for pheochromocytomas had shorter mean operating time and hospital stay; less intraoperative hypertension or intraoperative blood loss; less postoperative analgesia requirement, and earlier return to oral nutrition [26].…”