Transperitoneal versus retroperitoneal laparoscopic adrenalectomy for large pheochromocytoma: Comparative outcomes

Abstract

Objectives To evaluate operative and oncological outcomes of laparoscopic adrenalectomy through a transperitoneal approach and retroperitoneal approach for large (>5 cm in diameter) pheochromocytomas. Methods We retrospectively compared the results of a transperitoneal approach with those of a retroperitoneal approach in 22 patients (mean age 57.5 years, range 38–76 years) with unilateral large pheochromocytomas (12 right, 10 left). The mean body mass index, operation time, pneumoperitoneum time, estimated blood loss, fluctuation in blood pressure and complication rate were compared between the two approaches. Results The mean tumor diameter (range) was 7.0 cm (range 5.2–15.5 cm), and no significant differences were observed between the transperitoneal approach and retroperitoneal approach in any baseline clinical parameter. For right‐sided procedures, significant differences were found for operation time (113 vs 85 min), pneumoperitoneum time (93 vs 64 min) and estimated blood loss (96 vs 23 mL; P < 0.05, transperitoneal approach and retroperitoneal approach, respectively). No open conversion or recurrence was reported, but one right transperitoneal approach case required blood transfusion. No difference in these parameters was noted on the left side. Conclusions For right side procedures, the retroperitoneal approach is feasible, safer and faster than the transperitoneal approach for large pheochromocytomas. Early transection of the feeding artery is beneficial for managing the tumor and reducing the risk of bleeding.

Laparoscopic transperitoneal and retroperitoneal adrenalectomy: a 20-year, single-institution experience with an analysis of the learning curve and tumor size [lap transper and retroper adrenalectomy]

“…The incidence of large, 6-10 cm adrenal tumors is 8.6-38.6%, showing malignancy in a quarter of the cases [23]. Tumor size shows direct correlation with chances of malignancy, although size is not always a reliable predictive factor.…”

Comparison of the retroperitoneal versus Transperitoneal laparoscopic Adrenalectomy perioperative outcomes and safety for Pheochromocytoma: a meta-analysis

“…7). Shiraishi et al reported a retrospective study that found that TLA had a higher incidence of hypertensive crisis than PRA (58% vs 40%, retrospectively) [19]. Wessel et al performed a retrospective, multicenter study that included 341 patients and found that the overall and cardiovascular morbidity rates were comparable between the two approaches [23].…”

“…Four studies were included in our study [16][17][18][19]. The PRISMA flow diagram of the search process is summarized in Fig.…”

Successful laparoscopic resection of a paraganglioma immediately behind the inferior vena cava and bilateral renal veins

“…In this case, we chose the transperitoneal approach. Shiraishi et al . reported that the retroperitoneal approach is feasible, safer, and faster than the transperitoneal approach for large right‐sided adrenal pheochromocytomas because early transection of the feeding artery is beneficial to managing the tumor and reducing the risk of bleeding.…”

“…In this case, we chose the transperitoneal approach. Shiraishi et al 8 reported that the retroperitoneal approach is feasible, safer, and faster than the transperitoneal approach for large right-sided adrenal pheochromocytomas because early transection of the feeding artery is beneficial to managing the tumor and reducing the risk of bleeding. However, for paragangliomas such as those in our case, we choose the transperitoneal approach over the retroperitoneal approach because it can provide a wide operative space, preparations for open conversion can be simultaneously made during the surgical procedure, we can more easily recognize the anatomical relationship between the tumor and abdominal organs, and hand-assisted surgery is inappropriate when securing a wide operative space.…”