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

Abstract

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.

Laparoscopic adrenalectomy using the lateral retroperitoneal approach: Is it a safe and feasible treatment option for pheochromocytomas larger than 6 cm?

“…In a prospective study of 163 PCC patients, it was shown that LA can be carried out safely and successfully for tumors >6 cm without suspicion of malignancy with results comparable with treatment of smaller tumors. 6 Similarly, in the present study, the group showing a large tumor size had longer operating time and greater estimated blood loss with more significant change in hemoglobin levels compared with those belonging to the small-sized tumor group. However, there was no significant difference with respect to surgical complications and intraoperative and postoperative outcomes between both groups.…”

“…4 Despite improvements in surgical techniques and perioperative management, LA for PCC is a challenging procedure because of the risk of intraoperative hemodynamic instability. 5 Recently, several reports have shown the safety and effectiveness of LA for PCC, but the indications for using the laparoscopic approach for large tumors remain debatable, 6 and most laparoscopic procedures are carried out using the transperitoneal and/or posterior retroperitoneal approach. 7,8 The aim of the present study, carried out at a single hospital, was to evaluate the surgical feasibility of LA using the lateral retroperitoneal approach for PCCs larger than 6 cm without extra-adrenal extension, and to identify the preoperative risk factors for intraoperative hypertension.…”

Recurrent phaeochromocytoma along the laparoscopic portal sites

“…1 Recent studies have suggested that laparoscopic adrenalectomy is also safe for large phaeochromocytomas (≥6 cm) without preoperative suspicion of malignancy. [2][3][4] However, our case illustrates that laparoscopic adrenalectomy can be associated with recurrence of phaeochromocytoma, even in the absence of unequivocal evidence for malignancy preoperatively, due to local seeding of the tumour. The localisation of the recurrent tumours at the sites of ports for laparoscope and the absence of distance metastases on the MIBG scan Letters to the Editor (Fig.…”

“…There are effective evidencebased strategies for managing pain and other symptoms in people with cancer, yet evidence shows that Watts' experience is not an isolated one. 2,3 Watts' call to prevent this from happening to others in the future is a timely one and one we echo.…”

Experiência De 20 Anos Em Adrenalectomia Videolaparoscópica

“…Essa técnica permite melhor visualização da complexa anatomia da região, menos dor pós-operatória, menos tempo de internação e retorno mais rápido às atividades diárias. Há relatos na literatura de menos complicações operatórias, menor perda sanguínea, menor necessidade de transfusão de hemoderivados e melhor resultado cosmético [10][11][12] . As complicações intraoperatórias mais descritas na literatura são: sangramento, lesões de outros órgãos e estruturas anatômicas, e pneumotórax.…”