Surgical management of organ-contained unilateral pheochromocytoma: comparative outcomes of laparoscopic and conventional open surgical procedures in a large single-institution series

Abstract

Laparoscopic procedures are feasible and as safe and effective as open procedures for patients with organ-contained pheochromocytoma. In a patient cohort where majority of the patients had large (>6 cm) pheochromocytoma, laparoscopic procedures resulted in lesser morbidity and shorter convalescence and provided equal chance for cure of pheochromocytoma and hypertension as conventional open surgical procedures.

Laparoscopic Adrenalectomy for Removal of Unilateral Noninvasive Pheochromocytomas in 10 Dogs

“…In people, controversy has surrounded the treatment of large pheochromocytomas and some studies have suggested that tumors >6 cm resected laparoscopically will lead to greater blood loss and may be associated with a higher conversion rate . Others have contended that large tumors can readily be approached using laparoscopic adrenalectomy and have not reported differences in morbidity or mortality between laparoscopic adrenalectomy and open adrenalectomy for large tumors . A recommendation in dogs has been made that an upper limit of 5 cm maximal diameter be used as a reasonable guide for case selection in adrenocortical tumors .…”

“…Laparoscopic removal of adrenal gland masses has continued to gain popularity since its introduction to human medicine in 1992 and has increasingly been reported in dogs and cats . Reported advantages of laparoscopic adrenalectomy over an open approach in people include limited manipulation of other abdominal organs, improved visualization, fewer wound complications, decreased postoperative discomfort, and an overall decrease in morbidity and mortality …”

“…In human medicine, laparoscopic management of pheochromocytoma is well‐established . Recent reports document the outcomes in dogs of clinical cases undergoing laparoscopic adrenalectomy for resection of adrenocortical neoplasms .…”

Clinical Guidelines for the Management of Adrenal Incidentaloma

“…Although no prospective randomized study compares those two methods, large, single-institution studies reported that laparoscopic adrenalectomy is associated with reduced pain, bleeding, hospital stay, and postoperative complications [9495]. Thus, minimally invasive adrenal surgery, such as laparoscopic adrenalectomy, is recommended for most adrenal pheochromocytoma.…”

Pheochromocytoma/Paraganglioma: Review of Perioperative Management of Blood Pressure and Update on Genetic Mutations Associated With Pheochromocytoma

“…In addition, improved outcomes have been associated with laprascopic surgery for PCC compared with open procedures. 37,38 Risk factors for hemodynamic instability include large tumors >3 to 4 cm, higher catecholamine levels, uncontrolled blood pressure, or orthostatic hypotension preoperatively. 2 Therefore, medical management, including perioperative blockade, is believed to be important to lower morbidity and mortality of PCC/ PGL resection.…”