Is the laparoscopic adrenalectomy for pheochromocytoma the best treatment?

Toniato, Antonio; Boschin, Isabella Merante; Opocher, Giuseppe; Guolo, Annamaria; Pelizzo, Mariarosa; Mantero, Franco

doi:10.1016/j.surg.2006.10.012

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Volume 141, Issue 6 , Pages 723-727, June 2007

Is the laparoscopic adrenalectomy for pheochromocytoma the best treatment?

Antonio Toniato, MD
- Institute of Surgical Pathology, Department of Medical and Surgical Sciences, University of Padua School of Medicine, Italy
- Reprint requests: Antonio Toniato, MD, Clinica Chirurgica III, University of Padua School of Medicine, Policlinico Universitario, via Giustiniani 2, Padua, 35128, Italy.
Isabella Merante Boschin, MD
- Institute of Surgical Pathology, Department of Medical and Surgical Sciences, University of Padua School of Medicine, Italy
Giuseppe Opocher, MD
- Endocrinology Unit, University of Padua School of Medicine, Italy
Annamaria Guolo
- Department of Statistics, University of Padua School of Medicine, Italy
Mariarosa Pelizzo, MD
- Institute of Surgical Pathology, Department of Medical and Surgical Sciences, University of Padua School of Medicine, Italy
Franco Mantero, MD
- Endocrinology Unit, University of Padua School of Medicine, Italy

Accepted 15 October 2006.

Background

Laparoscopic adrenalectomy has become the gold standard for removing adrenal masses, but several authors still debate the role of laparoscopic adrenalectomy in pheochromocytoma. The purpose of this study was to evaluate the short- and long-term outcomes of laparoscopic versus open adrenalectomy for pheochromocytomas and to compare the feasibility and safety of laparoscopic adrenalectomy for neoplasms that are smaller than 6 cm versus those that are larger than 6 cm.

Methods

From January 1990 to December 2005, the same team in our department carried out 221 adrenalectomies in 211 patients. A total of 64 of these patients underwent 71 adrenalectomies for pheochromocytoma, 24 patients (37%) had open adrenalectomy, and 40 patients (63%) had laparoscopic adrenalectomy. Sex, age, side and size of lesion, operating time, duration of hospital stay, need for intensive care, intraoperative blood pressure variations, blood loss, postoperative analgesia, return to oral nutrition, and complications were compared among groups.

Results

An advantage of laparoscopic adrenalectomy over open adrenalectomy was observed in mean operating time, hospital stay, need for intensive care, intraoperative hypertension, intraoperative blood loss, postoperative analgesia, and return to oral nutrition (P ≤ .035 in all). The analysis of tumor size (≤6 vs >6 cm) in laparoscopic adrenalectomy showed that none of the variables differed significantly, except for intraoperative blood loss, which was greater for the larger neoplasms (P = .007).

Conclusions

Laparoscopic adrenalectomy, when performed by experienced laparoscopic surgeons, is preferable to open adrenalectomy for the majority of pheochromocytomas, and as long as there is no evidence of invasion of surrounding structures, tumor size does not appear to have a profound effect on surgical outcome.