[Does the size of pheochromocytoma influence the results of its laparoscopic excision?].
BACKGROUND
The tumor size is considered as a limitation for laparoscopic adrenalectomy. The aim of this study was to assess diagnostic characteristics, hemodynamic modifications, and outcome of intraperitoneal laparoscopic adrenalectomy according to the size of pheochromocytoma.


METHODS
Retrospective study from January 1997 to December 2000. Results were evaluated according to the size of pathologic study (< or > or = 5 cm).


RESULTS
Forty two patients underwent laparoscopic adrenalectomy during this period. Among them, 11 (26%) were operated on for adrenal pheochromocytoma (6 patients < 5 cm and 5 patients > or = 5 cm). Preoperative systolic hypertension was 138 mmHg and 178 mmHg respectively (p = 0.01). Urinary metanephrine/normetanephrine rate was 1.259 and 0.268 respectively (p = 0.08). Capsular tumor effraction rate was 27%. Tumor size was 37% larger than that estimated by CT scan (24% versus 52%). Mean hospital stay was 10 days and 8 days respectively. Morbidity and mortality were 18% and 0%. All these criteria were not statistically significant among the two groups of patients.


CONCLUSIONS
Pheochromocytoma size > or = 5 cm do not modify outcome of patients but is responsible for preferential noradrenaline secretion and stronger hemodynamic modifications. Tumor fragmentation rate and CT scan size underestimation seem important in this group of patients. These characteristics have to be integrated to improve laparoscopic adrenalectomy outcome of patients with pheochromocytoma > or = 5 cm.
Brunaud
L
L
Service de chirurgie digestive, endocrinienne et viscérale, CHU Nancy-Brabois, 11 allée du morvan, 54511 Vandoeuvre les Nancy, France. lbrunaud@planete.net
Cormier
L
L
Ayav
A
A
Klein
M
M
Roumier
X
X
Zarnegar
R
R
Bresler
L
L
Boissel
P
P
D000310:Adrenal Gland Neoplasms / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D005260:Female; D006439:Hemodynamics; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D010673:Pheochromocytoma / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome