Pheochromocytoma: operative strategy

We studied 28 patients who had undergone 30 operations for pheochromocytoma since 1964. The tumor types included bilateral, extra-adrenal, malignant, recurrent, and multiple endocrine neoplasia, with 20 tumors confined to the adrenal gland. The preoperative studies used to localize the tumor include...

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Bibliographic Details
Published inSurgery Vol. 98; no. 5; p. 927
Main Authors Cullen, M L, Staren, E D, Straus, A K, Doolas, A, Shah, R, Patel, S, Economou, S G
Format Journal Article
LanguageEnglish
Published United States 01.11.1985
Subjects
Adolescent
Adrenal Gland Neoplasms - diagnosis
Adrenal Gland Neoplasms - physiopathology
Adrenal Gland Neoplasms - surgery
Adult
Aged
Animals
Female
Humans
Male
Middle Aged
Neoplasm Recurrence, Local
Pheochromocytoma - diagnosis
Pheochromocytoma - physiopathology
Pheochromocytoma - surgery
Preoperative Care
Retrospective Studies
Splenectomy
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Summary:We studied 28 patients who had undergone 30 operations for pheochromocytoma since 1964. The tumor types included bilateral, extra-adrenal, malignant, recurrent, and multiple endocrine neoplasia, with 20 tumors confined to the adrenal gland. The preoperative studies used to localize the tumor included ultrasonography, intravenous urography, angiography, and computed tomography. Patients underwent exploratory operations via flank, subcostal, bilateral subcostal, midline, or thoracoabdominal approaches. In one case, that of a recurrence after bilateral adrenalectomy, surgical exploration discovered a tumor that had not been localized during the preoperative workup. Two patients underwent splenectomy because of injury incurred during operative exploration. Our experience suggests that preoperative localization is highly reliable, and therefore the benefits of extensive surgical exploration may be outweighed by its risks. We believe that with the exception of tumors that occur in association with childhood or pregnancy, multiple endocrine neoplastic syndromes, or recurrent disease, a direct approach to the tumor, possibly via the flank, is justified. Our results suggest that exploration of the contralateral adrenal or periaortic area is not so important as to be worth jeopardizing the spleen or other organs by a complex or extensive dissection.
ISSN:0039-6060