Advertisement

Iatrogenic pheochromocytomatosis: A previously unreported result of laparoscopic adrenalectomy

      Abstract

      Background. Laparoscopic adrenalectomy is now regarded as the procedure of choice for treatment of small or benign adrenal tumors, including pheochromocytoma. However, long-term outcomes have not been critically assessed. We report here 3 cases of pheochromocytomatosis recurring 3 to 4 years after laparoscopic adrenalectomy. We postulate laparoscopic-induced seeding of tumor as the mechanism of recurrence. Methods. We retrospectively reviewed the cases of 3 patients with documented biochemical and radiolabeled metaiodobenzylguanidine evidence of recurrent pheochromocytoma after prior presumed curative laparoscopic adrenalectomy. Results. Original pheochromocytomas were 5.5 to 6.5 cm in diameter. At the time of laparoscopic adrenalectomy, tumors were not believed to be malignant, based on clinical or histopathologic data. However, on 3- to 4-year follow-up, each patient developed symptoms, elevated urinary catecholamine levels, and metaiodobenzylguanidine imaging consistent with recurrence. At reoperation, multiple small tumor nodules were found in the adrenal bed near the site of the initial laparoscopic resection. The original operative notes suggested some possible method of local seeding: tumor fragmentation and spillage or excessive tumor manipulation. Conclusions. Pheochromocytoma recurrence may occur as a result of local spillage of tumor during laparoscopic adrenalectomy. The relative risk of recurrence between open and laparoscopic resection needs to be assessed. Long-term follow-up will continue to be important, regardless of operative approach. (Surgery 2001;130:1072-7.)
      To read this article in full you will need to make a payment
      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Smith CD
        • Weber CJ
        • Amerson JR.
        Laparoscopic adrenalectomy: new gold standard.
        World J Surg. 1999; 23: 389-396
        • Bonjer HJ
        • Sorm V
        • Berends FJ
        • Kazemier G
        • Steyerberg EW
        • de Herder WW
        • et al.
        Endoscopic retroperitoneal adrenalectomy: lessons learned from 111 consecutive cases.
        Ann Surg. 2000; 232: 796-803
        • DeCanniere L
        • Michel L
        • Hamoir E
        • Hubens G
        • Meurisse M
        • Squifflet JP
        • et al.
        Multicentric experience of the Belgian Group for Endoscopic Surgery (BGES) with endoscopic adrenalectomy.
        Surg Endosc. 1997; 11: 1065-1067
        • Gagner M
        • Pomp A
        • Heniford BT
        • Pharand D
        • Lacroix A.
        Laparoscopic adrenalectomy: lessons learned from 100 consecutive procedures.
        Ann Surg. 1997; 226: 238-246
        • Pujol J
        • Viladrich M
        • Rafecas A
        • Llado L
        • Garcia-Barrasa A
        • Figueras J
        • et al.
        Laparoscopic adrenalectomy. A review of 30 initial cases.
        Surg Endosc. 1999; 13: 488-492
        • Castilho LN
        • Medeiros PJ
        • Mitre AI
        • Denes FT
        • Lucon AM
        • Arap S.
        Pheochromocytoma treated by laparoscopic surgery.
        Rev Hosp Clin Fac Med Sao Paulo. 2000; 55: 93-100
        • Col V
        • de Canniere L
        • Collard E
        • Michel L
        • Donckier J.
        Laparoscopic adrenalectomy for phaeochromocytoma: endocrinological and surgical aspects of a new therapeutic approach.
        Clin Endocrinol. 1999; 50: 121-125
        • Fernandez-Cruz L
        • Saenz A
        • Benarroch G
        • Sabater L
        • Taura P.
        Does hormonal function of the tumor influence the outcome of laparoscopic adrenalectomy?.
        Surg Endosc. 1996; 10: 1088-1091
        • Gagner M
        • Breton G
        • Pharand D
        • Pomp A.
        Is laparoscopic adrenalectomy indicated for pheochromocytomas?.
        Surgery. 1996; 120: 1076-1079
        • Inabnet WB
        • Pitre J
        • Bernard D
        • Chapuis Y.
        Comparison of the hemodynamic parameters of open and laparoscopic adrenalectomy for pheochromocytoma.
        World J Surg. 2000; 24: 574-578
        • Janetschek G
        • Finkenstedt G
        • Gasser R
        • Waibel UG
        • Peschel R
        • Bartsch G
        • et al.
        Laparoscopic surgery for pheochromocytoma: adrenalectomy, partial resection, excision of paragangliomas.
        J Urol. 1998; 160: 330-334
        • Joris JL
        • Hamoir EE
        • Hartstein GM
        • Meurisse MR
        • Hubert BM
        • Charlier CJ
        • et al.
        Hemodynamic changes and catecholamine release during laparoscopic adrenalectomy for pheochromocytoma.
        Anesth Analg. 1999; 88: 16-21
        • Mobius E
        • Nies C
        • Rothmund M.
        Surgical treatment of pheochromocytoma: laparoscopic or conventional?.
        Surg Endosc. 1999; 13: 35-39
        • Walther MM
        • Keiser HR
        • Linehan WM.
        Pheochromocytoma: evaluation, diagnosis, and treatment.
        World J Urol. 1999; 17: 35-39
        • Plouin PF
        • Chatellier G
        • Fofol I
        • Corvol P.
        Tumor recurrence and hypertension persistence after successful pheochromocytoma operation.
        Hypertension. 1997; 29: 1133-1139
        • Obara T
        • Kanbe M
        • Okamoto T
        • Ito Y
        • Yamashita T
        • Ito K
        • et al.
        Surgical strategy for pheochromocytoma: emphasis on the pledge of flank extraperitoneal approach in selected patients.
        Surgery. 1995; 118: 1083-1089
        • Van Heerden JA
        • Roland CF
        • Carney JA
        • Sheps SG
        • Grant CS.
        Long-term evaluation following resection of apparently benign pheochromocytoma(s)/paraganglioma(s).
        World J Surg. 1990; 14: 325-329
        • Brennan MF
        • Keiser HR.
        Persistent and recurrent pheochromocytoma: the role of surgery.
        World J Surg. 1982; 6: 397-402
        • Fraker DL
        • Travis WD
        • Merendino JJ
        • Zimering MB
        • Streeten EA
        • Weinstein LS
        • et al.
        Locally recurrent parathyroid neoplasms as a cause for recurrent and persistent primary hyperparathyroidism.
        Ann Surg. 1991; 213: 58-65
        • Sivula A.
        Recurrence of benign phaeochromocytoma by intraoperative implantation.
        Acta Chir Scand. 1974; 140: 334-339