Laparoscopic adrenalectomy for pheochromocytoma

Kalady, Matthew F.; McKinlay, Rodrick; Olson, John A.; Pinheiro, J.; Lagoo, Sandhya A.; Park, A.; Eubanks, William S.

doi:10.1007/s00464-003-8827-0

Cited by 77 publications

(23 citation statements)

References 21 publications

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“…Th ey concluded that LA for PHEO, including large tumors, is safe, feasible, and eff ective with appropriate perioperative hemodynamic control (Hirayama et al 2015). Th e same was concluded by other authors (Jaroszewski et al 2003;Cheah et al 2002;Kalady et al 2004;Kercher et al 2005;Mezzadri et al 2010;Sommerey et al 2015).…”

Section: Surgery Of Pheochromocytomasupporting

confidence: 77%

Pheochromocytoma, diagnosis and treatment: Review of the literature

Farrugia

Martikos

Tzanetis

et al. 2017

Endocrine Regulations

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Objective. We conducted an extensive review of the literature and tried to cite the most recent recommendations concerning the pheochromocytoma (PHEO).Methods. Pub Med and Google Scholar databases were searched systematically for studies concerning pheochromocytomas (intra-adrenal paragangliomas) from 1980 until 2016. Bibliographies were searched to fi nd additional articles.Results. More than four times elevation of plasma fractionated metanephrines or elevated 24-h urinary fractionated metanephrines are keys to diagnosing pheochromocytoma. If the results are equivocal then we perform the clonidine test. If we have not done it already, we preferably do a CT scan and/or an MRI scan. Th e patient needs pre-treatment with α1-blockers at least 10-14 days before operation. Alternatives or sometimes adjuncts are Calcium Channels Blockers and/ or β-Blockers. Several familial syndromes are associated with PHEO and genetic testing should be considered.Conclusions. Th e biggest problem for pheochromocytoma is to suspect it in the fi rst place. Elevated metanephrines establish the diagnosis. With the proper preoperative preparation the risks during operation and the postoperative period are minimal. If there is a risk of the hereditable mutation, it is strongly suggested that all the patients with pheochromocytoma need clinical genetic testing.

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Section: Surgery Of Pheochromocytomasupporting

confidence: 77%

Pheochromocytoma, diagnosis and treatment: Review of the literature

Farrugia

Martikos

Tzanetis

et al. 2017

Endocrine Regulations

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“…Blood loss also is reported to be higher with PHE [16,17]. Furthermore, there is variability in the reported morbidity for LA, with higher complication rates reported for PHE patients than for non-PHE patients [8,19].…”

Section: Discussionmentioning

confidence: 78%

“…Most reports indicate that the tumor size for a PHE is significantly larger than for a non-PHE [15,16]. Interestingly, no consensus exists regarding the influence that this has on the operating time [15][16][17][18]. The complexity of the dissection as it relates to the increased vascularity and vasoactive characteristics of PHE may contribute to this inconsistency.…”

Section: Discussionmentioning

confidence: 87%

Pheochromocytoma does not increase risk in laparoscopic adrenalectomy

et al. 2010

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“…In contrast to other adrenal tumors, pheochromocytomas present as a management challenge, due to their size, vascularity, and demanding pre-, intra-, and post-operative care, secondary to their hormonal secretion. A cancer diagnosis is also of concern, as 5–6% of pheochromocytomas are malignant (4–6). As a result, a diagnosis of pheochromocytoma was once considered a contraindication for laparoscopy.…”

Section: Introductionmentioning

confidence: 99%

Safety and Feasibility of Laparoscopic Resection for Large (≥ 6 CM) Pheochromocytomas Without Suspected Malignancy

et al. 2012

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Objective The safety and efficacy of laparoscopic adrenalectomy has been well documented and it has become the standard of care for benign adrenal pathology, and small (<5cm) pheochromocytomas. Its applicability for pheochromocytomas larger than 6 cm has been questioned, due to concerns including cardiovascular complications, malignancy, and recurrence. The aim of this study is to determine if laparoscopic adrenalectomy in patients without radiologic evidence of cancer, compromises the peri-operative and long-term outcomes of large ≥6 cm pheochromocytomas. Methods We analyzed a prospective adrenal database of 163 consecutive patients who underwent adrenalectomy at our institution between September 2000 and September 2010, under an Institutional Review Board approved protocol. Patients diagnosed with a pheochromocytoma, who underwent laparoscopic adrenalectomy (LA) were investigated. Patients with tumors <6 cm (SmPheo) were compared to those presenting with tumors ≥6 cm (LgPheo). Results Twenty-five patients presented with 26 pheochromocytomas. There were 52% females with a mean age of 53±3. The mean tumor size was 5.2±0.5cm and 11 (42%) pheochromocytomas were ≥6 cm. The tumor size was significantly different between the LgPheo and the SmPheo groups (7.6±0.4 vs. 3.6±0.4 cm, p<0.001) but there was no significant difference in intra-operative complications, estimated blood loss, cancer diagnosis, or recurrence. The length of stay was comparative amongst the two cohorts and there were no incidents of capsular invasion or adverse cardiovascular events. Conclusion Laparoscopic adrenalectomy of pheochromocytomas larger than 6 cm is feasible and safe with comparable results to smaller ones.

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Laparoscopic adrenalectomy for pheochromocytoma

Abstract: Despite concern about increased operative times and morbidity associated with pheochromocytoma, our experience supports that laparoscopic adrenalectomy may be performed as safely as, and achieve outcomes similar to, those for other diseases.

Cited by 77 publications

References 21 publications

Pheochromocytoma, diagnosis and treatment: Review of the literature

Pheochromocytoma, diagnosis and treatment: Review of the literature

Pheochromocytoma does not increase risk in laparoscopic adrenalectomy

Safety and Feasibility of Laparoscopic Resection for Large (≥ 6 CM) Pheochromocytomas Without Suspected Malignancy

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