Laparoscopic adrenal surgery for recurrent tumours in patients with hereditary phaeochromocytoma.
OBJECTIVE
To report our experience with Laparoscopic Partial Adrenalectomy (LPA) for recurrent tumours in patients with hereditary phaeochromocytoma.


METHODS
Five patients with hereditary phaeochromocytoma (4 with von Hippel-Lindau disease and 1 with Multiple Endocrine Neoplasia 2B), who had undergone adrenal surgery previously, presented with recurrent adrenal tumours. One patient was pregnant at 20 weeks of gestation. All patients underwent hormonal evaluation, genetic screening and imaging with CT or MRI, metaiodobenzylguanidine (MIBG) scintigraphy.


RESULTS
Of the 7 attempted LPA in five patients, five procedures (71%) were successfully completed and total adrenalectomy was needed on two occasions. The adrenal vein could be spared in all patients except one. There were no intra-operative complications. The adrenal function was adequate in all patients without need for steroid supplementation except one patient who lost both adrenals eventually. There was no correlation between the preservation of adrenal vein and adrenocortical function.


CONCLUSIONS
Laparoscopic partial adrenalectomy is feasible, safe and effective in recurrent phaeochromocytoma, despite previous adrenal surgery and is technically easier if the previous approach had been laparoscopic as well. Patients with hereditary phaeochromocytoma are prone for recurrent tumours and may need repeated surgical procedures. Hence, minimally invasive approach is ideal for these patients.
Nambirajan
Thiagarajan
T
Department of Urology, Elisabethinen Hospital, Linz, Austria. tnambirajan@hotmail.com
Leeb
Karl
K
Neumann
Hartmut P H
HP
Graubner
Ulrike B
UB
Janetschek
Günter
G
D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D002648:Child; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*; D010673:Pheochromocytoma / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*; D011247:Pregnancy; D012449:Safety; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome