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

• Published in: International journal of urology Vol. 25; no. 5; pp. 414 - 419
• Main Authors: Chung, Ho Seok, Kim, Myung Soo, Yu, Ho Song, Hwang, Eu Chang, Kim, Sun‐Ouck, Oh, Kyung Jin, Jung, Seung Il, Kang, Taek Won, Park, Kwangsung, Kwon, Dong Deuk
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01.05.2018
• Subjects: Adrenal Gland Neoplasms - surgery; Adrenalectomy; Adrenalectomy - adverse effects; Adrenalectomy - methods; Adult; Female; Hemoglobin; Humans; Hypertension; Hypertension - etiology; Intraoperative Complications; Laparoscopy; Laparoscopy - adverse effects; Linear Models; Male; Middle Aged; Multivariate Analysis; Operative Time; Patients; Perioperative Care; pheochromocytoma; Pheochromocytoma - surgery; Postoperative Complications; Republic of Korea; Retroperitoneal Space - surgery; Retrospective Studies; Risk Factors; Tumors; Republic of Korea; adrenalectomy; laparoscopy; pheochromocytoma; hypertension
• ISSN: 0919-8172; 1442-2042
• DOI: 10.1111/iju.13524

Objectives To evaluate the surgical feasibility of laparoscopic adrenalectomy using the lateral retroperitoneal approach for the treatment of large pheochromocytomas, and to identify the preoperative risk factors for intraoperative hypertension. Methods We retrospectively reviewed 51 patients who underwent laparoscopic adrenalectomy using the lateral retroperitoneal approach for the treatment of pheochromocytomas. Patient characteristics and perioperative outcomes were analyzed and compared between the two study groups based on tumor size: group A (n = 27, ≤6 cm) and group B (n = 24, ˃6 cm). Results There was no significant difference in preoperative characteristics between the two groups except for tumor size (P = 0.001) and urinary metanephrine (P = 0.011). Group B patients required longer operating time (P = 0.008), had a greater estimated blood loss (P = 0.001) and hemoglobin change (P = 0.002). However, no significant differences were observed in perioperative complications and mortality. Multivariate analysis showed that symptomatic pheochromocytomas (P = 0.004) and tumor size (P = 0.007) were significant risk factors for intraoperative hypertension. Conclusions Laparoscopic adrenalectomy using the lateral retroperitoneal approach for pheochromocytomas can be regarded as a treatment option, even for tumors measuring >6 cm. Symptomatic pheochromocytomas and large tumor size seem to represent risk factors for intraoperative hypertension.