Prospective randomized comparison of laparoscopic versus open adrenalectomy for sporadic pheochromocytoma

• Published in: Surgical endoscopy Vol. 22; no. 6; pp. 1435 - 1439
• Main Authors: Tiberio, Guido A. M., Baiocchi, Gian Luca, Arru, Luca, Agabiti Rosei, Claudia, De Ponti, Simona, Matheis, Albert, Rizzoni, Damiano, Giulini, Stefano M.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.06.2008; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adrenal Gland Neoplasms - diagnosis; Adrenal Gland Neoplasms - physiopathology; Adrenal Gland Neoplasms - surgery; Adrenalectomy - methods; Adrenals. Adrenal axis. Renin-angiotensin system (diseases); Adult; Aged; Biological and medical sciences; Blood Pressure - physiology; Carbon Dioxide - administration & dosage; Digestive system. Abdomen; Endocrinopathies; Endoscopy; Female; Follow-Up Studies; Gastroenterology; General aspects; Gynecology; Hepatology; Humans; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy - methods; Laparotomy - methods; Magnetic Resonance Imaging; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Monitoring, Intraoperative - methods; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Pheochromocytoma - diagnosis; Pheochromocytoma - physiopathology; Pheochromocytoma - surgery; Pneumoperitoneum, Artificial - methods; Proctology; Prospective Studies; Severity of Illness Index; Surgery; Tomography, X-Ray Computed; Treatment Outcome; Adrenalectomy; Laparoscopy; Pheochromocytoma; Open surgery; Endocrinopathy; Secretory tumor; Medicine; Endoscopic surgery; Treatment; Sporadic; Endoscopy; Comparative study
• ISSN: 0930-2794; 1432-2218; 1432-2218
• DOI: 10.1007/s00464-008-9904-1

Background Laparoscopic adrenalectomy for pheochromocytoma remains subject of debate, owing to the systemic consequences of pneumoperitoneum in patients with catecholamine-secreting tumors. Methods A prospective randomized study was conducted (2000–2006), evaluating cardiovascular instability during open ( n  = 9, group A) or laparoscopic ( n  = 13, group B) adrenalectomy for pheochromocytoma. Haemodynamic parameters were recorded by invasive monitoring. Results Haemodynamic instability was observed in 3/9 (group A) and 6/13 patients (group B), with a mean of 1.8 and 2.2 hypertensive peaks per patient ( p  = n.s.). Blood loss (164 ± 94 cc versus 48 ± 36 cc, p  < 0.05) and operative time (180 ± 40 versus 158 ± 45 min, p  = n.s.) favored laparoscopic procedures. Postoperative morbidity and mortality were nil. Hospital stay was shorter in group B ( p  < 0.05). Long-term follow-up was always normal. Conclusions Laparoscopic approach for pheochromocytoma can be as safe as open surgery; intraoperative haemodynamic instability, although usually controlled with success, remains a source of concern.